L N. MSPC U A

n ♦/I publication of the Medical Society of Pierce County jjj VOL. 2, NO. 1 705 South 9th, Suite 203 JANUARY 1987 Tacoma, Washington 5 7 2 - 3 6 6 7 PHYSICIAN DRGs AMA TO DRAFT LEGISLATION IN in RESPONSE TO PROBLEMS IN FRO HOSPITAL SETTING Dick Bowe Installed as SANCTIONS PROCESS 94th Society s a result of being besieged President at At the American Medical ith telephone calls and Gala Annual Meeting Associations Interim Meeting ther communications demon- of the House of Delegates, trating the professions Richard G. Bowe, ophthal­ December 8 and 9, the House iverwhelming opposition to a mologist and member of the stopped short of seeking iRG concept for physicians, Society since 1972 was repeal of the Medicare Peer ,he Administration has backed installed as the 94th Review Program. But, iff from its position that President of the Medical focusing on problems with ayment for all inpatient Society of Pierce County at the sanctions process, ihysician services should be the Annual Joint Dinner delegates charged the AMA .umped into hospital DRGs. Meeting December 9. with developing draft federal legislation to prevent the ’or the time being, at least, Dr. Bowe is a graduate of PRO’s from sending denial he Administration has modi­ the University of Washington letters to beneficiaries fied its prior position School of Medicine. He is until cited physicians have ’avoring universal implemen- a Diplomate, Am. Board of exhausted their rights of ;ation of physician DRGs in Ophthalmology and a member appeal. lospital settings starting of the American Association .n FY-1988. of Ophthalmology as well as HEALTH FAIR NEEDS the American Medical VOLUNTEERS -t has however, refused to Association. judge so far from its posi­ The Tacoma Mall Health Fair He and the newly elected tion that in-hospital ser­ is scheduled for February officers and trustees were vices for anesthesiologists, 14, 15 and 16. This Fair installed at the Annual Pathologists and radiologists gives members of the Meeting held at the Tacoma should be included in the Society an opportunity to Sheraton Hotel. William lospital DRG payments. meet the public and perform Jackson, Radiologist, is a unique public service. WHAT TO DO... President Elect. Volunteers are asked to AMA is urging all members to Reelected to serve a second spend two hours at the contact their Republican term as Vice President was Society’s booth. Blood representatives, urging that Kenton C. Bodily, Vascular pressure tests will be they advise White House Surgeon and Secretary- given and brochures handed Congressional staff of the Treasurer, Robert B. Whitney, out. to booth visitors. profession’s total opposition radiologist. to inclusion of payments for Congratulations go to the If you would like to physician’s service in a Newly elected trustees who volunteer, please call DRG. The Administration are: Sally Palm-Larson 588-5258 must clearly understand that Gerald W. Anderson, General or the Medical Society the physician DRG concept is Surgeon...Ronald W. Knight, office at 572-3667. anathema to the entire Cardiac Surgeon and Eileen profession. Toth, Internist. MSPC NEWSLETTER 1 JANUARY 1987 FOR SALE

For sale: Walnut exam table with matching treatment cabinet, medicine chest, stools and wastebasket. Also a Castle Autoclave, Burdick EKG, centrifuge, multiple cautery units, file cabinets, and assorted instruments and office hardware. Contact: Dr. M.E. Lawrence, Fox Island, 549-2416.

Hoitar Monitor 1400 includes training. Phone 474-3329.

Surplus medical equi pment . Large i.rv, ent < >ry of diagnostic, office and home care equip­ ment. Prices extremely reasonable. Call Lynda ( 206 ) 453-8892.

OFFICE SPACE

UNIVERSITY PLACE PROFESSIONAL SQUARE - Medical Center. Improved, suites at reasonable rates . 565-4 1 14 .

DOWNTOWN MEDICAL SUITES - Newly remodeled, improvements to tenants needs. Individual suites and shared, offices. Parking Available. Reasonable rates. 383-5500/565-4444.

FIRST YEAR RENT FREE. Ideal Lease Package for Specialty Practice or Team. Immediately available-: 1754 square f >t in contemporary office near hospital. Lorac Ltd., South Seattle. 1-206-244-::'915 .

Office space with in-office lab and x-ray facilities to share with two sub-specialists in the Cedar Medical Center. Rent with option to buy. 1901 So. Cedar, Tacoma WA 272-2261 or 572-3520.

POSITIONS & PRACTICES

FT positions in Tacoma clinic. Also PT. Hourly rates plus malpractice. Flexible scheduling. Any State License. Other Opportunities. Call NES 1-800-554-4105.

Excellent practice opportunities immediately available for outstanding BC/BE family, general and internal medicine practitioners. First year income potential to $80,000. Office space and marketing support provided for those eager to build a strong practice in a supportive medical environment in metropolitan Seattle. For more information, phone or- write, include C.V.: Recruitment Commit1oe, West Seattle Community Hospital, 2600 South West Holden Street, Seattle WA 98126, (206) 938-6000.

0 1jmini Lted family practice physician needed by urban Native American community for challenging and fulfilling practice. Excellent medical community, ideal location with nearby moiintains, b^a<:-h

PSYCHIATRIST - Full time or part-t ime contractual p o s i t i o n available w i t h Comprehensive Mental Health Center. Requires board eligible psychiatrist w i t h completion of three- year residency i n psychiatry', licensed to practice medicine in the State of Washington. Responsibilit ios include client evaluation for medication, hospitalization, diagnosis or s p e c i a l I real merit, p-* :■ 'mmonda hi ons and clinical consultation to Center s t a f f . Quali­ fied applicants may subnn I resume to CMf-IC, 1201 So. Proctor, Tacoma, WA 98405. EOE.

MSPC NEWSLETTER 2 JANUARY 1987 MEMRKRS SUPPORT LAYMAN BOARD APPROVES . . . that the C'ommi ttee on OH @IEVANCE COMMITTEE EIGHT FOR MEMBERSHIP Aging be commended for improving communications In October the membership The Board of Trustees between the Society and the was polled to determine if approved for membership the Senior Citizens of Pierce one or two laymen should be following applicants at its County. appointed to the Grievance December 3 meeting. Committee. ...that the Society has been asked to review the impact It was felt that the credi­ C . Zeno Andersen... on pediatric care in the bility and image of the Radiologist county as a result of the Committee and organization Arthur R. Knodel... move of Mary Bridge Hospital would be improved by the Pulmonary to K wing of Tacoma General move. Robert R. Livingston... Hospital. Radiology WSMA, King County Medical John C. Park...... the following were Society and the State General Practice elected to serve as Medical Disciplinary Board Robert F. Rauktis... Directors of the Society’s have had made such appoint­ Radiology wholly owned for-profit ments and are gratified by Elizabeth G. Sanford... subsidiary Membership the results. Ob-Gyn Benefits Inc: Jens Strand... The results of the survey Colo-Rectal Surgery Mark A. Gildenhar with a 42.1% (294)response Richard S. Tobin... Donald Shrewsbury rate was: in support of the Radiology Kevin Schoenfelder proposal were 186 (63.3%) Terrill Utt... John Stewart members and 108 (36.7%) Family Practice Alan White opposed R . Ivan Zbaraschuk Other Board actions were: The Board of Trustees at the Dr. Whitney will serve December meeting voted to Reaffirmed its decision to as Secretary-treasurer for have the President and strongly encourage appli­ MBI by virtue of the Bylaws. Grievance Committee Chairman cants to attend the DAMAGE CAP RULED appoint one or two laymen to Credentials Committee UNCONSTITUTIONAL the committee for a period orientation meeting. of one year. However, attendance would not be mandatory for A U.S. District Court, in consideration of the Virginia ruled. Nov. 5 that application. a Virginia law placing a $1 million cap on medical malpractice awards is uncon­ ...Urge WSMA to pursue the creation of a social stitutional because it infringes on the right to admi asi ons DRG. trial by jury. ...that the Grievance Commit.tee Chairman and MSPC The ruling casts doubt on the legality of similar President could appoint one laws in other states, said or lay member's to the Committee. Virginia Medical Association counsel Allan Goalsby III. . . .that the Grievance Although state courts in WAMPAC Committee should hear Illinois and Ohio have held grievances against caps unconstitutional, physicians who are not Virginia’s was the first to members of the Society. be struck down by a federal court. State courts in Indiana, Louisiana, and Nebraska have found caps constitutional.

MSPC NEWSLETTER 3 JANUARY 1987 POSITIONS AND PRACTICES

ENT Physician — Outstanding practice opportunity available for fulltime, board certified otorhinolaryngologist. Fully equipped and furnished office located in prime medical office building with established referral network. Office space and marketing support provided for selected physician eager to quickly build an active practice. Mail C.V. and letter of professional goals to: "Medical Staff Specialist, 1906-D, S.W., 318th Place, Federal Way, WA 98023.

Wanted, retired cardiologist for part-time research work at Blood Pressure Research Clinic. Washington license required. Call 357-6689 or write Blood Pressure Research Clinic, 140 No. Percival Street, Olympia, WA 98502.

MEDICAL DIRECTOR POSITION - Providence Medical Center in Seattle is soliciting appli­ cations for the position of Medical Director. Applicants interested in further infor­ mation concerning job description and position qualifications should contact either Peter Bigelow, Administrator at Providence Medical Center, or Gerold F. Garrett, M.D., Chairman of the Medical Director Search Committee. Inquiries to either of these indi­ viduals should be directed to Providence Medical Center, 500 - 17th Avenue, Seattle, WA 98124.

Crossroads Treatment Center Alcoholism g a i Presenting The Pacific A Program Designed to Provide Comprehensive T reatment for ■ i Northwests First Regional All Facets of Alcoholism Seminar On Gerontological Nursing Physician Directed March 25, 26, 27 Family Treatment Included Cost Effective Outpatient For the first time, more than 30 of the Pacific Northwest's Program leading specialists in the field of geriatric care join in a symposium aimed at making nurses and other health-care pro­ Covered by many Health fessionals more expert in caring for the elderly. Insurance Plans Headed by Richard Waliman, M.D.. FACT. this intensive pro­ FOR INFORMATION gram explores' the aging process and its effect on body systems. CONTACT: Attendees will be eligible for 15 CERP credits. For an informa­ Ted Berning, Administrator tive brochure about the seminar, write or call: 5909 Orchard St, West Tacoma, WA 98467 - - J Humana" Hospital-Tacoma Nursing Administration (206) 473-7474 m i l Tacoma, WA 9X-J] i-(HI i (2116) 572-2325, Ext. 7219 \ 5 ? CROSSROADS TREATMENT Humana Hospital-Tacoma CENTER B rining the human being in need into the hands ol a d o n o r ' 1 An Approved Washington Alcoholism Treatment Facility

MSPC NEWSLETTER 4 JANUARY 1987 JANUARY RF-ADHvV: ROY D. BROMAN, M.D., Family OLEG E. GORDIENKO, M.D., JAN M. GORTON, M.D., Pvgf.'fir.p/l-jniTgf'Mcy Med i - General Medicine. Born in Pediatric*-. Born in cine. it'. Vancou\vi', Russi a, 07/20/-13 . Medical l.onavic.', Washi n.gton , Canada, 5/23/37. Medical Soho-d , Altai State Medicai C'9/20/49. Me-dicu.l School , School, University of British School, 1967 ; i nternslup, r 'niversi ty of Washington, Columbia, 1962: internship, Barnaul <> nera.1 Hospi t a i , 198(i; internship, Mary Deaconess Hospital, 19C12- USSR, 09/67-09/68; re-iden--y, Iniogene Bassett, NY, 07/81' 63; residency, Memorial Novos i 1 >) <-sJi Cen1 ;a ] Hospi I al , 07/81 and SU\T-Hca]th Sri*.. ■nrc Hospital, Internal Medic-ine, USSR, Internal Medicine, (enter of Syracuse, Pedia­ 1963-64. Washington State 08/70-08/73 ; anGeneral Surgery, 07/80- 06/78. Washington State 06/84; graduate training, License, 1985. Dr. Witt is Childrens Hospital of currently practicing at 9112 Pittsburgh, 07/84-present. Lakewood Drive S.W., Tacoma. Washington State License, WAMPAC 1986.

COLLEGE OF MEDICAL EDUCATION C ateg o ry I Continuing Medical Education THE LAW AND MEDICINE METABOLIC M ALADIES SYMPOSIUM Advance Registration Required January 28, 1987 January IS, 1987 6 2 7 -7 1 3 7 Brittle Diabetes: Clinical Malpractice Defense Experiences Features k Methods of Doctors and Lawyers: Improving Control Time, Money and Records Reactive Hypoglycemia: Tbe Malpractice Insurance Crisis Fact or Fiction? Our Adversary System of Justice Stalking the Thyroid Nodule When you are Sued . . . Premenstrual Syndrome: Recent Changes In Personal Injury Hormonal and Psychiatric Laws and Tort Reform A spects Criminal Lav and Medicine Obesity - A Epidemic of Great Proportions Coordinator: Marcel Malden, M.D. A Practical Approach to *<%> The Hypercalcemias Osteoporosis: Recent Developments in Diagnosis and Therapy

Coordinator: Ronald Graf, M.D.

MSPC NEWSLETTER 5 JANUARY 1987 A COMMUNITY FORUM: THE SYSTEM HEALTH CARE FOR THE YOU’VE BEEN WATTING FOR UNINSURED Single user to multi-user | Endorsed by the Medical Society of yterce County" During the 1987 Legi slat ivre session, measures will be Medical Systems considered to try to remedy the problem faced by people who have no health insurance.

A community forum will tie held on Wednesday, January 7, 1987 from 5 to 7 p.m. in Council Chambers of the Tacoma Municipal Building, 747 Market Street. IBM - IBM COMPATIBLES Physicians are urged to Why spend time getting your system up attend. and running when we can do It for you. Training. System Installation "Currently 420,000 low and Patient Accounts Transferred moderate income individuals Follow up for month end statements in the State have no health Complete service and support insurance and are not eli­ for hardware and software gible for state assistance CAR€ €NT€fiPftlS€S. INC. such as Medicaid," said Ms. A sk for G all Norris-Smlth Beyer, Attorney, and member 711 Commerce , Suite 200 of the Washington Health Care Tacoma. WA 98402 Project Commission. (206)383-3657 i AUTHORIZED DEALER FOR Who will pay?? c.m.cnmpuTERainc. How much will it cost??

Ms. Beyer and Joe King, Speaker of the State House of Representatives will describe the legislative WSMA CONTRACT proposals and answer questions. EVALUATION SERVICE What wilt the HMO or PPO do fo r you? Health care providers are urged to att en d . WTiat do they require of you? Will you assume a greater liability risk? How will it affect your practice and referral patterns?

Find out before you sign.

The WSMA provides a free, objective, written analysis of an HMO or PPO contract to WSMA members. The analysis explains the provisions of the contract, points out areas that are vague, and suggests areas that should be clarified. The WSMA does nol make a recommendation re­ garding which contract you should sign. WSMA members desiring a writ­ ten contract analysis should send a copy of the contrad to: Washington Stale Medical Association 2033 Sixth Avenue, #900 Seattle, WA 98121

MSPC NEWSLETTER 6 JANUARY 1987 LEGISLATURE t o c o n v e n e These issues 'ill require - presentat. i ves: your attention and offers Several important issu es you the opportunity to 2nd District oommunieate your opin ions K ill be coming before the Ken Madsen...... 786-7912 to your repr>js»'lit.ai i ve in 1987 session of the .Mari J yn Rasmussen. .786-7656 Legislature that convenes O l ' - u )[.»i ?.i. 25th District on Monday, January 12. Dan Grimm...... 786-r9rM George Walk...... 786-7SMH Please read the following 26th District KNOW YOUR LEGISLATOR?? partial list of legislation Hon Meyers...... 786-7964 to be considered by the Wes Pruitt...... 786-7802 1987 Legislature and you With the important 27th District will realize that some legislation tu be considered Ruth Fishor...... 786-7930 crucial decisions will be in 1987, if is imperative Art Wang...... 786-7974 made having a major impact that >ou know your- legislator- 28th District on medicine. and how to reaeh him/her. Sails- Walker...... 786-7890 Shirley Wirisle\ . . . .786-7958 1) TORT REFORM.. - it is Listed below by Legisjati\e 29th District critical that the ground District is the legislators T-'. J . Gal 1 agher 786-7906 gained in 1986 not be lost :ind telephone number. You Brian Fberso] e 78ti-7996 in *87’, We are asking can write them at this 30th District the legislators to give SB address: Jean Marie Brough..786-7830 4-63Q an opportunity to Dick Sehoon...... 786-7898 prove itself. Represenative______Senator ______2) MIRA (Medical In.iury LegisLat ive Bui Iding Reform Act).. .An alternative Olympia, WA 98504 PICTORIAL DIRECTORY dispute resolution system. A system which encourages Legislative Hot Line is: Plans are underway lor the expedited payment of 1-800-562-6000 local production of an MSPC economic and related losses Pictorial Directory. MBI to a person who has suffered Call the Hot Line number to will be responsible for injury or loss. leave a message with your production and distribution legislator. - please call Sue at 572- 3) INITIATIVE #92...This 3709 ? f you have any ideas initiative would mandate Senators: or suggestions. Tentative Medicare Assignment . .WSMA plans include photographs is urging its defeat so it 2nd District to be taken in February/ will have to go on the 1987 R. Ted Bottiger . .. 786-70 02 March with a final distri­ general election ballot. 25th District bution date in June, 1987. Marcus Gaspard..... 786-7648 4) Uncompensated Care.. .WSMA 26th District is encouraging support and Bill Smitherman....786-7650 adoption of the recommen­ 27th District 1987 PHYSICIANS DIRECTORY dations of the WA. Health Lorraine Wojahr.... '<86-7652 Care Project Commission 28th District The 1987 Directories are which would provide health Stan Johnson...... 786-76:,4 noi-, available 1 hru MBI. care for the poor and 29th District Fsery member has been uninsured. A.L. Rasmussen.....<86-7656 nmi t< • 1 a compl imentary 30th District 1 ■’ >j o . I f V( >u 'van t 111 5) MEDICAL DISCIPLINARY Peter von ReichK-juer ivj;-i--hasr^ add.it ional copies, BOARD...WSMA is proposing ...... 786-7658 jj 11'as;-1 o;-i 1 ! MPT for an to provide the Board with order forvi. Cost is $8.50 authority as well as f'.i members. responsibility.

MSPC NEWSLETTER 7 JANUARY 1987 COMPUTERIZING YOUR OFFICE ( OR YOUR HOME? Tacoma-Seattle The seminar on "Computer Systems in the Physician’s O f f i c e ” s p o n s o r e d by the College of Medical Education on November 22 ^ ^lEV>^ ir t S was a big success. Nearly 90 registrants heard speakers describe how Lo select a computer, EXPO contracting with vendors,and the future of computers in the You are cordially Invited lo atlend the Tacoma-Sealtle Medical Products Expo: physicians office.

P la c e Tacoma Sheraton Over 16 vendors had their 1320 Broadway Plaia Bicentennial Pavilion equipment there for all D a le —.Thursday, January 15, 1987 participants to view and T im e 12 Noon to 6 p.m. Complimentary Wine & Cheese t o u c h . Served 5:00 p.m. to 6:00 p.m. As a result of the Featuring Major Manufacturers ot Lab and Diagnostic Equipment Exam Room Furniture, General Supplies and much more, plus...A Drawing lor a VOn interest in the seminar (.he Medical Society is ' R.S.V.P. (206) 365-9900 forming a Computer User Group for anyone interes­ S p onsored b y ^ BIDDLE & CROWTHER Companyj ted in any aspect of computers--novices to experts . I The first meeting of the group is scheduled for 7:00 p.m., Wednesday, January 14, Tacoma General Hospital (Conf. R m . #5).

GRADUATING SENIORS!!

The Auxilliary would like to recognize all our graduates this year. If you have a son or daughter graduating from high school, vocational school, college, graduate school, etc., please take a moment to fill this out and return it to the Medical Society office or Marge Ritchie, 4803 95th Ave. W., Tacoma, 98467, by April 1.

Student’s Name______

Parent’s Name

Graduating from

Degree or Diploma received

Future plans

X MSPC NEWSLETTER 8 JANUARY 1987 AUXILIARY NEWS GOURMET (SCOTTISH)

Friday, January 17, marks If the post-holiday doldrums the first Auxiliary meeting have hit, and you’re looking ^DIAPER RASH^t of the new year. JoAnn for a little excitement in Johnson, Legislative Chair­ your life, consider joining IS NOT A WAY OF LIFE man, has put together an the Gourmet Group on January You can recommend professional informative program for us 24 for a real Scottish din­ diaper service w ith confidence. on "How to Communicate with ner {complete with haggis) to • Laboratory Controlled. Each month your Politician." So instead honor the birthday of Scot­ a random sample of our diapers is of just thinking "I should tish poet, Robert Burns. subjected to exhaustive studies in a write a letterwe can Recipes are supplied for biochemical laboratory. learn how to do our com­ different dishes, and each » U tm o s t Convenience. Thanks to p ick municating right! Join us couple is responsible for up and delivery service, our product at 10:00 a.m. at the home bringing a dish which adds comes when you need it of Ginny Miller, 4629 N. to the fun. Gourmet cooking • Economical. All this service, all th is Mullen, Tacoma. Reser­ experience is unnecessary, protection against diaper rash costs vations can be made by but please call Mary far less than paper diapers — only pennies more a day than home- calling Rubye Ward 272-2688, Schaeferle (627-2716) or washed diapers, Alice Yeh 565-6929 or Mimi Elaine Brown (588-9124) by CAUTION TO YOUR PATIENTS. It is illegal to Jergens 1-851-5720. January 10 in order to make dispose of human excrement in garbage. reservations. Parents are doing this with paper/plastic HEALTH FAIR diapers. “Disposable" is a misnomer. FASHION SHOW The annual Pierce County Health Fair has been sche­ Wednesday, March 18, 1987, duled for February 14, 15, marks the Fashion Show given and 16 at the Tacoma Mall, by the PCMS Auxiliary, the TACOMA WA TOLL FREE and once again our Auxiliary Tacoma Orthopedic Guilds, 383-BABY 1-800-562-BABY will offer free blood pres­ the Tacoma Junior League, Washington's Oldest, Most Trusted sure checks. Sally Palm- and the Tacoma Stars. It Professional Diaper Service Serving Our Second Generation Larson (588-5939) will will be held in the Tacoma welcome volunteers, so if Dome with pre-events such as you can spare a couple of color analysis, fashion and hours during that time, beauty tips, and hair please give her a call. styling beginning at 10:30 Husband-wife teams are with luncheon and the fashion welcome, but not a show following. Chairwomen requirement. Myrna Nagle and Susie Wiese are requesting that each A big "THANK YOU" to all of Auxiliary member sell one you who contributed toward extra ticket in addition to the $12,240.00 which was their own purchase if pos­ sent to the American Medical sible, but the money for MEDICUS Cleaning Service Association Education and them should be sent before Residence & Private Offices Research Fund from our February 1. Tickets are Holiday Sharing Card. available from Karen Dimant, 3519 13th Ave. Ct. N.W., Gig (206) 565-9317 Eva Oravetz Thanks, too, to Shirley Harbor 98335, for a total of 5503 39th C. E. Owner Keiranan, Carolyn Modarelli $20.00 each. Since this is Tacoma, WA 98466 and Kay Plonsky who worked the only fund raiser for the to make it all another year, let’s make it a big successful year, and to success! Mark Plonsky who supplied the cover design for the card.

MSPC NEWSLETTER 9 JANUARY 1987 LUNCHEON MEETING FOR RETIRED MEMBERS AND SPOUSES WEDNESDAY, JANUARY 14TH, 1987

"A Look at the Media" with Mr. Ben Gilbert Retired "City Editor - Washington Post (20 years)"

DATE; Wednesday, January 14, 1987

TIME: Lunch 12:00 Noon; Program - 12:45 P.M.

PLACE: Tacoma Dome Hotel (Hickman South Room) COST: Lunch, $9.50 per person

Register now. Please complete the attached reservation form and return it, with a check for the appropriate amount made payable to the Medical Society of Pierce County, in the enclosed envelope, or call the Medical Society Office, 572-3667 to confirm your attendance.

Reservations must be made no later than Friday, January 9. REGISTRATION:

______Please reseve______lunch(es) at $9.50 per person (tax and gratuity included). Enclosed is my check for $______.

______I regret I am unable to attend the lunch portion of the meeting. I will attend the program only. Dr.______

RETURN TO MSPC BY NO LATER THAN JANUARY 9.

MSPC NEWSLETTER 10 JANUARY 1987 MSPC CONSIDERING ORGANIZING TRAVEL GROUP

Would you be interested in joining 30-50 of your colleagues and spouses for a week of vacation and education at one of the following? Please check an area that would interest you enough to participate with a group travel plan.

Hawaii _____Sun Valley Orlando China New Orleans Aspen Paris SunRiver OR New Zealand London/Scotland Other

Favorite time of year to travel . . . Winter Spring Summer Fall

Favorite activity when vacationing . . . G o l f ____ Sightseeing Beach Skiing

O th er

COMMENTS:

iSAflJJHjj N£I ifJiEM

Care Enterprises, Inc., would like participants of the November 22nd Computers In Medicine seminar to note the following corrections regarding the vendor questionnaire that was distributed: 1( CEI has over one-hundred installations, the twenty-five listed would pertain to the Pierce County area alone, 2) CEI software installation on a single-user system (with all updates) is $450. per year; being totally optional, 3) CEI hardware maintenance is unique in that they will totally replace defective parts and have replacements on the shelf (contractually agreed), on the single-user system maintenance for hardware can cost as little as $10.00 per month, and, 4) the phone number for CEI was incorrect, please change to 383-3657, and ask for Gail Norris-Smith.

CEI is endorsed by the Medical Society of Pierce County.

MSPC NEWSLETTER 11 JANUARY 1987 Custom RX Compounding Featuring Computerized Testing By Fastest Nat Progesterone Suppositories, Troche Tacoma's Finest Homes 25,50,100,200,400 mg.

Psychological, Vocational, Minoxidil Lotion Richard C. Pessemier Educational 1,2,3,4,5% Sales Associate Adult and Children

Harold B. Johnston, MD, P.S. Union Avenue Pharmacy 272-4138 OFI ICE 754-2699 HOME Allemnore Medical Center, B-3009 2302 S. Union Ave. South 19th & Union Tacoma Swanson-McGoldrick, Inc. Tacoma, WA 98405 w^hi\< ,ro\ mjimiNc m im Mr 752-1705 I A C O M .A . YY A SI 11N G T ( ) N Telephone 383-2413

PHYSICIANS

Your Army Reserve Personnel C o u n selo r would like to talk to you about the following opportunities in the V S Army Medical Department:

PART-TIME IN COM E CONTINUING MEDICAL EDUCATION RETIREMENT PO TEN TIA L ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOR BY THE US ARMY RESERVE

Major Paul H. Lawhon, MSG 206 - 967-5046

USAR AMEDD Procurement. P.O. Box 38. Madigan Army Medical Center. Tacoma, WA 98431-5038

Many groups TALK about building a better America- The Army Reserve WORKS at It

MEDICAL SOCIETY OF PIERCE COUNTY pi ^ » 705 South 9th, Suite 203 BULK RATE U.S. POSTAGE Tacoma, Washington 98405 PAID TACOMA. WASH. PERM IT NO. 60S

j MEDICAL SOCIETY OF PIERCE COUNTY February, 1987 -r[r^ £ p : Physicians who prefer ——- medicine to paperwork.

We are looking for dedicated physi­ physicians who have joined the you are currently in a residency cians, physicians who want to be, not Army. Army Medicine is the perfect program such as Orthopedics, Neuro­ salesmen, accountants, and lawyers, setting for the dedicated physician. surgery, Urology, General Surgery, but physicians. For such physicians, Army Medicine provides wide-rang­ or Anesthesiology, you may be eligi­ we offer a practice that is practically ing opportunities for the student, ble for the A rm y’s Sponsorship perfect. In almost no lime you experi­ the resident, and the practicing Program. ence a spectrum of cases some physi­ physician. Army Medicine offers an attractive cians do not encounter in a lifetime. Army Medicine offers fully accred­ alternative to civilian practice. As an You work without worrying whether ited residencies in virtually every Army Officer, you receive substan­ the patient can pay or you will be specialty. Army residents generally tial compensation, extensive annual paid, and you prescribe, not the least receive higher compensation and paid vacation, a remarkable retire­ care, nor the most defensive care, but greater responsibility than do their ment plan, and the freedom to prac­ the best care. civilian counterparts and score tice w'ithout endless insurance forms, If that is what you want, .join the higher on specialty examinations. If malpractice premiums, and cash flow worries.

Army Medicine: AMEDD Personnel Counselor The practice that’s Building 138, Room 116 practically all medicine. Naval Support Activity (Sand Point) Seattle, WA 98115 (206) 526-3548/3307

Tel-Med A Library of Free Recorded Health Tips.

Over 200 topics, from tonsillectomy to osteoporosis, researched and written by physicians. Brochures listing these topics are free to you and your patients. If you would like a supply for your waiting room, please call 597-6655.

A Community Scrrirc Sponsored By: mty The Bulletin

The official publication of Ike Medical Society of Pierce County

MSPCOfficers: Richard G. Bowe, President; William B. Jackson, President-elect; Kenton C. Bodily, Vice President; Robert B. Whitney, 4 President’s Page Secretary-Treasurer; Richard Hawkins, Past GoalsfoM987 President.

MSPC Trustees: Michael L. Halstead, Peter K. 6 Newsbriefs Marsh, Paul D. Schneider, Johann H. Duenhoeiter 1987; Gerald W. Anderson, Ronald AMA Survey: Professional Liability main concern of physicians W. Knight, Eileen R. Toth, 1988, Susie Duff/. Richard Bowe, MD, assumes MSPC presidency Year in Review: Hospital Admissions Executive Director: Douglas R. Jackman Local clinic needs volunteers

Board and Committee Chairman: Bylaws: Stanley Tuell; Budget/Finance: Robert B. Whitney; College of Medical Education, Peter 7 Editorial Commentary K. Marsh; Credentials: Richard E. Waltman; Help, Somebody Do Something Emergency Medical Standards: James K. By Ben Blackett, MD Fulcher Ethics/Standards of Practice: Ronald G. Taylor; Grievance: Richard Hawkins; Interprofessional: Robert J. Martin; Legislative: Gregory A. Popich; Library: 11 Legislative Guide for 1987 Gilbert G. Johnston; Medical Education: David Brown; Medical-Legal: Marcel Malden; Membership Benefits, Inc., Donald W. 12 1986 Tax Reform Act Shrewsbury; Personal Problems of Physicians, Pat Donley; Program: KentonC. Bodily; Public Discusses effect on retirement plans for sole proprietors, Health/School Health, Terry Torgenrud; UHI associations, partnerships, professional corporations Quality Assurance: David Sparling; Committee on Aging: David R. Munoz. 14 Estate Planning for Today’s Physician The Bulletin is published quarterly, February, May, August and November, by the Medical By Ted. H. Finkelstein, Esq, Society of Pierce County, 705 South 9th, Suite Reprint from Westchester Medical Bulletin 203, Tacoma, WA 98405. Telephone (206) 572- 3666. Bulk Rate U.S. Postage paid at Tacoma, Washington. The Bulletin is published in the 17 Nursing Home Care interest of medicine and allied professions. The opinions herein are those of the individual Can physicians play a vital role in nursing home care? contributors and do not necessarily reflect the official position of the Medical Society. Acceptance of advertising in no way 20 Looking Back constitutes professional approval or Bridge Over Troubled Water, By Mavis Kallsen endorsement of products or services advertised. The Bulletin and the Medical Society of Pierce County reserve the right to reject any advertising. 24 Are you taking time to "Pick the Daisies?" Reflections on a life after 85 years Editor: David S. Hopkins

Managing Editor: Douglas R. Jackman 25 General Membership Meeting Notice Editorial Committee: David S. Hopkins Annual Joint Membership Meeting (Chairman), Stanley W. Tuell, W. Ben Blackett, Richard Hawkins

Production: Mary K. Tipton 26 Auxiliary News Auxi Quad Brunch, Feb. 20 Health Fair, Feb. 13,14,15 Advertising: Sue Asher, Membership Benefits, Fashion Show, March 18 Inc., Medical Society of Pierce County, 572-3709. Beverly Foley, 2607 Bridgeport Way West, Suite 2C, Tacoma, (206) 564-3839

1987 February The Bulletin 3 President's Page Goals for 1987

When was the last time j State Trial Attorneys are prepared Persons, and it is urging its you were asked about your goals to try to overturn these hard won members not to sign the Initiative. forthe future? I guess we have all | statutory changes. Important Common Cause and the Senior been asked that question many j changes in personal injury Lobby opted not to endorse the times in our careers, and I am sure compensation address the issues Initiative. Urge your legislators to none of us would be where we are of a non-economic cap, periodic | defeat the proposal. It would then now if we hadn't taken the time to payments, joint and several liability, j be referred to the voters on the put priorities in our lives and plan statute of limitations, liability of November 1987 general election carefully for each step along the officers and directors, and waiver of | ballot. way. I physician-patient privilege. We Being elected MSPC must get to know our legislators Uncompensated Care - WSMA is president has been a long-term and not hesistate to call them and recommending support of the goal for me, as I hope it will be for explain our views. Washington Health Care Project many of you. I look upon it as more I Commission proposal which would than just another nice honor, but Medical Injury Recover Act (MIRA) I create a state-subsidized health rather a "paying-your dues" - WSMA is expected to insurance program for nearly obligation that is going to entail reintroduce MIRA, an alternative 500,000 Washington residents considerable time, effort and dispute resolution system. The who cannot afford medical energy. I sincerely thank all of you system would expedite payment of insurance. The proposal would for giving me the opportunity to economic and related losses to a levy a sales tax on professional represent you, and I hope that I can person who has suffered injury or services such as those provided by continue the fine tradition of loss because of substandard care doctors, hospitals, architects and leadership that I have respected services. Presently, the average lawyers. There may be a better since I came to town in 1971. length of time from initiation of a method of financing the program. It’s important that you j malpractice case to settlement by Talk it over with your legislator. know where your officers and jury is 77 months. Without a jury Board are headed, and I'd like to trial the average length of time is 55 Medical Disciplinary Board - The outline some of my thoughts for months. In Washington, only 28 Board falls underthe Department the coming year. Bear in mind that cents of every premium dollar of Licensing and needs to be the Board in its monthly give-and- taken in actually goes to the injured strengthened financially and take meetings may not agree with party. The legal system consumes administratively to be more me and may over rule or propose i 56 cents of that dollar, the effective. The Society supports other more pressing issues. i remaining 16 cents is required for WSMA in this effort. Remember always that we administrative expenses. Urge represent you, and if you have your legislator to support MIRA. Medicaid Reimbursement - Many opposing views or feel we should i members of our Society are losing be addressing more important I Initiative #92 - Initiative 92 is an money each time they see a goals, please let us know. | initiative to the 1987 Washington welfare patient. Pediatricians are State Legislature which would currently being reimbursed far less Legislative Goals i mandate medicare assignment. If a for giving immunizations than the physician charged more than cost of the vaccine itself. This is an Tort Reform - Members of the Medicare's reasonable charge, the ongoing problem which we will medical community must be physician would be in violation of continue to face and try to prepared to defend tort reform bill, the Consumer Protection Act. The overcome. SB 4630, in the 1987 session of Initiative is opposed by the the Legislature. The Washington American Association of Retired Continued on n e x t page.

4 The Bulletin February 1987 Community Goals incorporation. Subsequently, its many of the above issues, we The Society will financial contributions may become offered the Society as a resource continue to work closely with the more predictable. for issues in the future. I hope I Tacoma-Pierce County Health The College of Medical may call on many of you for your Department and its leadership. Education likewise must have our expertise. I would also urge you to An improvement in pre- strong support or face the risk of join the Speakers Bureau to give hospital emergency medical care is falling before the ever increasing in- talks to many of the interested being sought. The EMS house education departments of groups in the area. Committee is reviewing the current our local hospitals. At the December structure and will be making a MBI (Membership General Membership Meeting, recommendation to the Board of Benefits, Inc.) continues to explore Richard Hawkins handed me the Trustees and to the March meeting profitable services for our members gavel and formally inaugurated me of the Pierce County Board of and has presently begun repaying as Society president. Afterwards, Health. lean-year debts to the Society. several people offered their AIDS education in The Society will congratulations, others their schools and fluoridation of city continue a close working condolences, and many asked if I water will continue to be relationship with our Auxiliary and knew what I was getting into. I presented. its members who have contributed thought I did, but after looking at The Society will greatly to the achievement of our what I just wrote, I’m not sure. continue to function as a forum for goals. I'vegottogo. I'vegot discussions of such items as: WHEW- work to do. ■ pediatric care, health care for Black Communication Goal Americans, EMS base stations and My personal goal for ~ Richard G. Bowe alternative delivery systems. 1987 is to improve medicine's image via increased Society Membership Goals exposure to the media and the The Society will work to public in general. We have already strengthen the Pierce County met with the editorial staff of the Medical Library by encouraging its TNT and in addition to discussing What’s new for physicians at St. Joseph Hospital?

♦ M obile L ith o trip sy U nit for non ♦ Tacoma Treatment Center for com­ surgical treatment of kidney stones; prehensive outpatient care of oncol­ service begins this spring. ogy patients and others needing IV therapy. ♦ CT Q uick S c an n er (GE 9800 Quick) and complementary software, unique ♦ H om e H ealth S erv ice providing a in the Puget Sound region; low-cost, range of services within the home set­ accurate osteoporosis screening; 3-D ting at lower cost than hospitalization. reconstruction for craniofacial recon­ struction and orthopedic surgery.

St. Joseph Hospital a physician partnership For more information, call 591-6767.

1987 February The Bulletin 5 Bowe Assumes Richard Hawkins, Immediate Past sound to require the committee to President nominate more than one candidate Presidency. MichaelL. Halstead, Trustee ( for each office, since the 1987) committee can easily circumvent PeterK. Marsh, Trustee (1987) such a provision by nominating Dr. Richard Bowe, PaulD. Schneider,Tru stee (1987) only one person who has any Opthamologist, was installed as the Johann H. Duenhoelter, Trustee chance of being elected." 94th President of the Medical (1987) Society at the Annual Joint Dinner Gerald W. Anderson, Trustee Meet the Public... Meeting held at the Tacoma (1988) Sheraton Hotel, Dec. 9. Ronald W. Knight, Trustee (1988) Provide a Service Dr. Bowe has practiced Eileen Toth, Trustee (1988) The Tacoma Mall Health in Pierce County since 1971. He Susie Duffy, Trustee (Auxiliary-87) served on the Board of Trustees Fair is schedu led for Feb. 13,14 and 15. Here is an opportunity for two terms prior to becoming The Board of Trustees you to meet the public and provide president-elect. He was president, meets on the first Tuesday of the a service (blood pressure testing) Membership Benefits, Inc., the month. If you have an issue you in a relaxed atmosphere. Society's for profit subsidiary 1979- would like the Society to discuss Volunteers, usually in 80. and review, contact any of the He is a member of husband and wife teams, are asked above officers ortrustees. to serve a two hour shift in the WSMA, AMA, American With regard to the Association of Opthalmology voting, four ballots had notes on booth. If you are interested in among others. A graduate of the them expressing dissatisfaction University of Washington School of with having no opportunity to vote volunteering, please call: Mrs. Medicine in 1964, Dr. Bowe and Sally Palm-Larson at 588-9839 or for more than one candidate. The his wife Sara reside in Gig Harbor. Bylaws of the Society previously the Society office 572-3667. required a minimum of two 48% of members candidates for each vacancy. In 1985, the Bylaws were amended Dr. John Hilger vote for Officers to no longer require two or more named president­ and Trustees. candidates. elect of AAFPRS The experience of the Dr. John Hilger, longtime The 1987 Board of Nominating Committee had been MSPC member, has been named Trustees election results showed to nominate as strong a candidate president-elect for the American over 48% of the membership took as possible forthe presidency. Academy of Facial Plastic and advantage of their right to vote. The Committee, then, had great Reconstructive Surgery 336 members cast a ballot for their difficulty finding a member who (AAFPRS). choice of who would lead their wanted to oppose such a strong, Dr. Hilger will assume Society in 1987. able candidate and face certain defeat. If the member elected to his duties as AAFPRS president in Sept., I987. The AAFPRS is an Elected were: oppose the strong nominee was international, multidisciplinary Richard G. Bowe, President defeated, this capable member organization of more the 2,700 William B. Jackson, President-Elect was reluctant to seek reelection board certified surgeons who Kenton C. Bodily, Vice President again. specialize in facial plastic and Robert B. Whitney, Secretary- It should be noted that reconstructive surgery. Treasurer Robert’s Rules of Order recommends "It is usually not Newsbriefs continued on page 7.

The Bulletin February 1987 Editorial Commentary.... Help Somebody Do Something! ( O r ) When confused and in doubt, run in circles, scream and shout. By Ben Blackett,MD

The changes upon us preserve your practice." (We have aJI seen physicians for now and the prospect of those to Medical liability whom medical practice was be in the practice of medicine have insurance rates that continue to everything in life, and who, evoked a variety ot physicians climb (I know a neurosurgeon in therefore, lost everything of responses: Florida who is paying $240,000/yr interest to them when age, premium for 7 million total coverage disability or situation made Some retire early. claims made, and he has had only 2 continued practice impossible). suits in ten years). Perhaps this seems too obvious to Some join every PPO, HMO, IPA HCFA has invented need saying, but sometimes the etcetera in sight. Super PRO to audit and if possible obvious is overlooked. I would call discredit Washington and other this the sanity self defense step. It Some stonewall ft. PRO'sthat have not administered will be even more important in the sufficient disciplinary sanctions future than it has been in the past. Some join unions. against physicians to please HCFA. Routine and mandatory Step Three: Develop commercial Some join non-union negotiating second opinion programs that interests through investment, groups. often delay needed treatment (no artistic ability, writing talent, argument where either the patient inventive or engineering ability,etc. Some restrict their range of or the treating physician wants a I know several medical families that practice. second opinion). own and manage stores and one Low welfare physicians' wite who is president of Some stop accepting welfare reimbursement which puts the a construction company. Some patients. greatest strain on the physicians physicians have been very with the largest welfare practices successful in developing new Some will stop accepting medicare (one would think a special subsidy surgical instrumentation. The patients. in orderfortaking on a large welfare possibilities are as great as your load). imagination and abilities. To the Most complain about it. But despite all of this, extent that you are successful, you the practice of medicine is for most build immunity to the economic Some write about it. of us the most challenging, most pressures of the new medical interesting and most satisfying way marketplace. And just think, if you Others do some combinatbn of to spend the day. /Note, some do well enough you could practice the above. days are better than others). The medicine purely for the pleasure trick is going to be for each of us to and satisfaction of making others There is before us a somehow maintain our feel better. This is the economic parade of specters to irritate, independence both professionally self defense step. frustrate and threaten any and economically. Three steps will cognitive physician. (Scrooge had be a good start. There are lots of only four spectors to contend with theories for banishing specters. If on his most memorable Christmas). Step one: Refuse to take part in you don't like any of the above The parade includes: any action or program that limits the suggestions, you can always wear DRG rules that conflict choice of what is best for the garlic. By the time this missive with what is best and safest forthe patient. goes to the printers, Christmas will patient. be over, so have a Happy 1987. ■ An almost metastatic Step Two: Develop hobbies proliferation of PPO's, each with its and/or sport interests that can — Ben Blackett own MBA trying to stampede provide a complete escape from physicians to "sign up now to the frustrations of medical practice.

February 1987 The Bulletin 7 Newsbriefs continued Dr. Dave Pomeroy says, Physician any questions, please call the "Thanks." Medical Society office at 572- Volunteers Needed 3667, or call the Clinic nurse, St. Leo's Trudy, at 627-4741. In the December Neighborhood Clinic needs our Newsletter Dr. Dave Pomeroy help. The Clinic, located at 1323 1987 Directory appealed for financial support via South Yakima, provides health care Corrections pledges to the American Lung to the homeless, needy and Association for his bicycle ride anyone who walks in the door. across the country. The Clinic is open two Singh, Surinderjit, M.D. (jeena) "The response has evenings a week, Monday and EMG, Phys Med & Rehab - Sat. Accept all patients been tremendous, says Dave, "far Thursday, from 6:00 p.m. to 8:00 Off: 1901 So. Cedar, Suite 302, beyond expectations, and I want to p.m. thank everyone for their generous Tacoma 98405 272-9994 If enough physicians Res: 701 No. Stadium Way support." could volunteer, one physician Dave will be riding his Tacoma 98403....627-5844 would not be called upon more Dr. Singh Was inadvertently omitted bicycle from Seattle to Atlantic City, than once every four or five from the 1987 Directory. Dr. Saroja N.J., as part of a Lung Association months to serve. The Clinic Singa should have been eliminated and bicycle trek. provides a badly needed service in was not. (Editors note: Dr. the community and offers all Pomeroy will continue to accept physicians, regardless of specialty Farber, Stuart, J. pledges if you have not done so an opportunity to participate. Office phone:...759-3586 already.) If you would like to take Dr. Farber’s phone number was listed part in a fine public sen/ice or have incorrectly as 752-0998. Please note correct number of 759-3586.

Hospital Sharma, Ramesh Dr. Sharma's name was not listed in admissions drop Crossroads Treatment Center bold print and is difficult to locate. says AHA Please make a note of Dr. Sharma's Alcoholism listing. Economic "Year in A Program Designed to Provide Review." Comprehensive Treatment for Correction stickers will be forwarded All Facets of Alcoholism for each copy of the 1987 Directory that you received to make the above Physician Directed Hospital admissions corrections. Please check your listings to make certain that they are dropped 4.6% in 1985, says a Family Treatment Included correct. If you have any corrections, recently released report by the please call Sue at 572-3709. Thank AHA’s Hospital Research and Cost Effective Outpatient Educational Trust (HRET). Program you. "Economic Trends: Covered by many Health Advertiser Correction: (See page 1985 Year in Review" reports Insurance Plans 26 In Directory). growing incentives for cost The Phone Connection effectiveness, increased FOR INFORMATION Phone No....(206) 851-8845 competition, and economic CONTACT: Mobile No...279-0163 recessions in some areas as T e d Berning, Administrator causes for the decline. The 5909 Orchard St. West biggest drop was seen in the over T a c o m a , WA 98467 Featuring 65 population, which had 5% fewer (206)473-7474 admissions in 1985 than 1984. Tacoma's Finest Homes The average length of stay for all patients dropped 1.1%; the Richard C. Pessemier number of outpatient visits rose Sales Associate 4.8% from 1984-1985. CROSSROADS TREATMENT CENTER 272-4138 O FFIC E 759-2699 HOME

An Approver/ Washington Alcoholism Swanson-McGoldrick, Inc. hv.ilnieiil l.idlity W A S H IN G T O N B U IL D IN G SUITE 302 T A C O M A , W A S H IN G T O N 91)402

The Bulletin February 1987| 1986 Joint Annual Meeting

Board of Trustees: Left to right, Kenton Bodily, Vice President; Dick Bowe (fight) presents outgoing President, Robert Whitney, Secretary-Treasurer; Barry Weled (1986); Richard Hawkins (left) a plaque of appreciation during Ronald Knight (1988); Richard Hawkins, Immediate Past the Annual Meeting and installation of new officers President; DeMaurice Moses (1986); Richard Bowe, President; and trustees. Charles Weatherby (1986); Peter Marsh (1987); Eileen Toth (1988).

Lett to right: Cindy (Charles) Anderson, Past President Pat Duffy (1984) Outgoing President Richard Marny (Don) Weber, Connie (Alan) Tice talks to outgoing President Richard Hawkins and his wrfe Sonja enjoy the festivities at the Annual Hawkins (left) and incoming with Richard (Dick) and Sara Joint Dinner Meeting. President Richard Bowe. Bowe. Dick Bowe succeeds Richard as President.

1987 February The Bulletin 9 Newsbriefs continued

conscious and more demanding There is not a high level of Physicians fee! than they used to be, but there is awareness, especially among the less certainty about patients' public, of AMA policy initiatives, continuing loss of willingness to follow prescriptions but there is widespread support and their satisfaction with the among both physicians and the control over treatment process. Still, most general public fora number of patient treatment physicians believe their patients positions the Association has feel generally positive about their taken. Physicians overwhelmingly decisions. visits. believe the AMA should continue to take strong positions on public Major findings of two There Is considerable health policies. surveys conducted by the AMA negative sentiment among during May and June, 1986, of the public toward doctors in A majority of American adults physician and public opinion on general, but the image is not believe Medicare payments should health care issues are as follows: getting worse, as had been the be based on patient income and case several years ago. Overall, would be willing to pay additional Physicians for the first time see public attitudes toward physicians taxes to ensure the program's professional liability as the main are fairly stable. contribution. Even larger numbers problems facing medicine. The would contribute to a "Health IRA.'1 public's continuing primary concern, cost, has fallen to second place among physicians.

The public is increasingly cognizant of a general liability insurance crisis, and substantial majorities are now sympathetic with physicians on a number of specific Manor Care issues related to malpractice insurance and suits. of Meadow Park CONVALESCENT AND REHABILITATION CENTER More American adults perceive a physician surplus than in years • 24 Hour Skilled past, but they are still more likely to Nursing Care report a shortage. Physicians indicate growing concern on • Long-Term and several items related to physician supply and competition. Vacation Stays

Most physicians feel a • Occupational, continuing loss of control Speech and over patient treatment Physical Therapies decisions and are very sensitive to that issue, • Medicare Certified reacting strongly against insurance plan provisions that require their decisions to be reviewed by • Deluxe Heritage persons other than practicing W ing physicians. For more information contact our Admissions Director Physicians generally see patients as more knowledgeable, more cost- 474-8421 5M)1 S. ORCHARD ST. • TACOMA L= ______Medical Director, John Atkinson, M .D.

The Bulletin February 1987 Your Legislative Guide.

Senators Olympia Key Physician Co Phone No. 2nd District R.Ted Bottiger(D) 786-7602 Don Pearson, MD

25th District Marcus Gaspard(D) 786-7646 William Marsh, MD

26th District Bill Smitherman (D) 786-7650 William Jackson, MD

27th District Lorraine Wojahn (D) 766-7652 Alan Tice, MD

28th District Stan Johnson (R) 786-7654 James D. Krueger, MD

29th District A.L. "Slim" Rasmussen (D) 786-7656 Stanley W. Tuell, MD

Legislative Mail Address: Senator_ .Legislative Bldg., Olympia, WA 98504

Representatives

2nd District Ken Madsen (D) 786-7912 Walter M. Arthur, MD Marilyn Rasmussen (D) 786-7656 James K. Symonds, MD

25th District George Walk 786-7948 Donald C. Weber, MD Dan Grimm (D) 786-7968 Michael Haynes, MD

26th District Ron Meyers (D) 786-7964 Donald Shrewsbury, MD Wes Pruitt (D) 786-7802 Paul Schneider, MD

27th District Ruth Fisher (D) 786-7930 Michael Jarvis, MD Art Wang (D) 786-7974 George Tanbara, MD

28th District Sally Walker (R) 786-7890 TerryTorgenrud, MD Shirley Winsley(R) 786-7958 Joseph Nichols, MD

29th District P.J. "Jim” Gallagher (D) 786-7906 David Brown, MD Brian Ebersole (D) 786-7996 Richard Hawkins, MD

Legislative Mail Address: Representative______Lesiglative Bldg., Olympia, WA 98504 For urgent and quick messages to your legislator call the Legislative Hot Line: Toll Free 1*800-562-6000, and leave your message. Olympia Telephone Numbers: WSMA Olympia Office (206)352-4848 Lobbyist Message Center...... 754-3206 (24 hr. answering for messages) (Capitol Building, "Ulcer Gulch")

1987 February The Bulletin The 1986 Tax Reform Act

The Tax Reform Act has been covered extensively by the press, particularly in regard to the elimination of investment tax credits, lengthening of estate depreciation and the "passive" income and loss provision. Given these changes, qualified retirement plans become even more attractive as an income shelter. The Act has a significant effect on many aspects of the retirement plans of sole proprietors, associations, partnerships and professional corporations.

Current law deductibility of up to $2,000 retained for tax payer and taxpayer spouse, TREATMENT OF TAX regardless of income, if they are not active participants in an employer-sponsored retirement FAVORED SAVINGS Individual Retirement plan, include tax-sheltered annuities, government plans, Simplified Employee Pensions Accounts (SEPs) and Keogh plans. Low income individuals also allowed deductibility, even if taxpayer or spouse is an active participant. The $2,000 deduction is phased out at income levels between $40,000 and $50,000 AGI for joint returns ($25,000 and $35,000, single). Individuals may make nondeductible contributions to a separate account to the extent they are ineligible for deductible contributions. Where one spouse has no earned income, the maximum on joint returns is $2,250. The nondeductible contribution will be subject to the same dollar limits for deductible contributions of $2,000 of earned income ($2,250 for a spousal account). Income in the account accumulates tax-free until distribution. Provision generally effective January 1 ,1987. Tax on early withdrawals is 10%.

Qualified Cash or Deferred Maximum annual elective deferral for an employee under most CODAs (ie 401 (k) plans) and Arrangements CODAs, 401 tax-sheltered annuities limited to $7,000 (indexed). Contributions to tax-sheltered annuities (k) plans for employees of public schools and certain tax-exempt organizations cannot exceed $9,500. Nondiscriminatory tests toughened. Highly compensated employee redefined (see below). Further limits placed on hardship withdrawals. Permits some withdrawals on account of plan termination. Employees may not be required to complete more than one year of service to be eligible. New CODAs not permitted for tax-exempt or public employees. The $7,000 401 (k) limit will be reduced for elective contributions to a tax-sheltered annuity. New rules for excess contributions.

Employer Matching and Employee matching contributions and employee contributions subject to single Employee Contributions nondiscriminatory tests as with CODAs. If they do not satisfy nondiscriminatory tests, excess contributions can be subject to 10% excise tax.

Special Rules for Adopts simplifying SEP amendments and permits elective deferrals to employees of small Simplified Employee f irms up to $7,000 (Essentially turns SEP plans in 401 (k) plans.) Contains language on Pensions (SEP) nondiscrimination and highly compensated employees similar to CODA section.

MINIMUM STANDARDS Qualified plans must cover: 1) 70% of nonhighly compensated employees covered, 2) a FOR QUALIFIED PLANS percentage of nonhighly compensated employees equal to at least 70% of the percentage of Coverage Requirements for highly compensated employees covered, 3) a reasonable classification test (imposed by Qualified Plans Treasury), or 4) an alternative classification test. New rules provided to determine excludible employees under latter rule.

Minimum Participation A plan must cover the lesser of 50 employees or 40% of nonexcludible employees. Plans Rules that do not comply after 1988 will be merged or terminated. Does not apply to multi-employer plans.

Top-Heavy Plans Applies a uniform benefit accrual rule in testing if qualified defined benefit plan is top-heavy. Determination can also be based on any accrual method if that method is used by all plans of an employer being tested.

Includible Compensation Limits the amount of compensation to be taken into accrual under any qualified plan or SEP at $200,000, increased as the defined contribution plan dollar limit is increased.

Benefit Forfeitures Forfeitures may be reallocated to remaining employees.

Vesting Generally, requires full vesting upon completion of five years of service or vesting at 20% after three years of serv.ce, increased by 20% each subsequent year until full vesting at n n )T ph '0n ^ V6Stlng required for multi-employer plans. Class year vesting not permitted. Effective generally after December 3 1 ,1988.

12 The Bulletin February 1987 And Your Retirement Plans Courtesy of San Francisco Medicine, Dec. 1986

Below is a general compilation of the most significant changes in the law, but note (hat you should consult with your plan administrator, attorney or accountant to determine tax reform’s impact on your plan.

By WardZumsteg. (MrZumsteg is a CMA Pension Specialist with E.F. Hutton)

WITHDRAWAL OF IRAs, qualified plans and tax-sheltered annuities, distribution no laterthan calendar BENEFITS year following the year in which participant attains age 70 1/2. Sanctions for not Uniform Minimum abiding by rules amount to a 50% excise tax on the excess of the minimum amount Distribution Rules required to be distributed over the amount actually distributed. Nondeductible tax borne by the recipient. Effective January 1,1989.

Withdrawals Before Age Generally, conforms to early withdrawal rules for qualified plans and tax-sheltered 591/2 annuities to the rules for IRAs (requiring a 10% tax on early withdrawal}. Exceptions include death, disability .distributions as part of a series scheduled by the plan and retirement at age 55.

Lump Sum; other Retain current law (ten year forward income averaging) for those who reached age Distribution Requirements 50 by January 1 ,1986. Otherwise allows only one time five year averaging after age 59 1/2; also phases out capital gains character of the pre-1974 portion of a lump sum distribution over a six year period. Extends restrictions to all tax-sheltered annuities. Repeals three year basis recovery rule and treats each distribution as part a payment of income and part a recovery of employee distributions.

Loans under Qualified Loans will be treated as distributions to the extent that they exceed the lesser of Plan $50,000 (minus the higher outstanding balance in the prior 12 months) or the greater of $10,000 and one half of the employee's accrued benefit. Exemption of five year repayment period is loan applied to principal residence purchase.

TAX DEFERRAL UNDER The $30,000 limit on annual additions to defined contribution plan is frozen until the QUALIFIED P U N S dollar limit on annual benefits under a defined benefit plan reachers $120,000. After Overall Limits on that, it is indexed to keep 4:1 ration. Limits on benefits commencing at normal Contributions and Benefits Social Security retirement age are: 100% of compensation or $90,000, whichever is less. Benefits obtained before or after normal retirement age must be actuarialfy adjusted to conform to limits. Limits are reduced for those with fewer than ten years under plan. Special rules providing for pilots and public sen/ants. Qualified supplemental costs of living arrangements permitted. For those receiving benefits from more than one plan, a 10% excise tax applies if the participant is receiving annual benefits more than 1.25 times indexed dollar limit of plan, with a $112,500 minimum for combined plans.

Retains current law on Social Security integration. Carry forward limit for these Deductions for plans is repeated. Contributions MISC PENSIONS AND DEFERRED Contributions to profit-sharing plan not limited to employer's current or accumulated COMPENSATION PROVISIONS profits. Discretionary Contribution TAXABLE YEARS OF PARTNER­ Must adopt the same taxable year as that of the partners owning a majority interest SHIPS, S CORPORATIONS, AND in profits and capital. If they do not have the same year, then the taxable year of PERSONAL SERVICE the principal partners applies. Otherwise, the calendar year must be adopted. CORPORATIONS Partnerships S Corporations Generally, must adopt the calendar year.

Personal Service Corporations Must adopt the calendar year and cannot deduct payments to owners/employees prior to the year paid. Exceptions to these rules must be approved by Treasury if a subsidiary business purpose for the change is given (that the taxable year provides deferral on income of three months or less is no longer a valid reason.)

1987 February The Bulletin 13 Estate Planning for Today's Physician

By Ted. H Finkelstein, Esq.

Several months ago, avoid a "treasure hunt" by the Logic would indicate executor for the decedent's two friends of mine went on a safari that the next step should be to assets. in Africa. Unfortunately, they determine the beneficiaries of the strayed from their tour group and estate. Logic is supplanted by found themselves in "hot water1' as Doctors must be aware that something that we all know is the main course of a pygmy dinner. their balance sheets are illogical—taxes. The estate and gift The pygmy chief, however, unique in that they list interests tax is a unified tax on all types of graciously granted each one a last in medical practices that are transfers of property during lifetime request. Friend one, a trust and difficult to value and even more and at death. The system was estate lawyer, stated that he had difficult to liquidate. orginally designed as a tax on the been trying to get his doctor superwealthy, but it has evolved companion to do an estate plan for into a tax on the affluent. The Even if the doctor is a shareholder years, and he requested that he be Federal graduated rates start at in a professional corporation with a permitted to lecture the doctor 18%, reach 41 % for a taxable buy-sell agreement, he still needs about estate planning before the estate of $1,000,000, and top off other liquid assets or insurance in doctor's demise. The pygmy chief at 55% for taxable estates his estate to compensate forthe then asked the doctor for his last exceeding $3,000,000. New York practice. request. The doctor thought for a few minutes and then pointed at Continued on page 15. the lawyer and begged to be eaten before the lawyer gave his estate planning lecture. Three W aysTo Im pr o v e The point of this apocryphal meal is that, to the bitter t o Local Econom y. end, doctors do not take the time to plan their estates. They In cluding Yo u r s. erroneously believe that the As a Pierce County-based bank, we feel a major com­ "dusty" wills in the bottom of their mitment to the local econ­ safe deposit boxes will take care of omy, a commitment you can their assets. Even the most see in everything we offer esoteric, state-of-the art will, ■ First, talk to us about our specialty: business b a n k in g . We may be able to save you plenty however, is ineffectual if a doctor's with individualized business checking, tailor- assets are not properly organized. made loans o ra line o lcrcdit. A will only disposes of property ■ Second, bank at one o l our convenient branch owned by a decedent outright, and offices. The lines are short—so you can get back to earning money faster. it does not affect assets such as life H Third, ask abtjut our combination business and insurance, pension plans, ortrust money market accounts. Some businesses have accounts which are payable to earned more in a year through their investments named beneficiaries. Most w ith us than they Ve made by working. importantly, a will has no effect on The Bank of Tacoma branch nearest you has plenty more property held by a decedent jointly ideas on how to improve the with a spouse or another person. Pierce County economy. Start The first step in the iny with yours. Call today. estate plan is to compile a detailed BANK OF 17%COI*l/% balance sheet so that the 7he Twee County bank ownership assets can be Downtown University Plate organized. The balance sheet will 593-5150 593-5190 c n i c°, 7 2 n d A P acilic Ave. i .ikew ood also serve as a locator map for the 593-5180 593-5170 593-5370 administraiton of the estate and MLMBLK rr DERAI DEPHSl IINM IRANII C0R1«0RATMN

14 The Bulletin February 1987 Estate Planning continued from page 14. Are you treating a patient exacts its share at lower rates rangingfrom2%to21%. The Federal tax is reduced by a credit with a head injury? tor part of the New York tax paid. There are two major estate tax exclusions. The decedent can leave unlimited Good Samaritan offers a continuum amountsto his surviving spouse of care and 5 treatment options free of tax. Both outright bequests to the surviving spouse and income-only trust where the for head injury patients. decedent controls who will ultimately receive the property after the surviving spouse's death (known as "QTIP" trust), will qualify forthe marital deduction. In 1 Inpatient acute rehabilitation addition, Congress has bestowed upon each of us something called a u nrfied credit against the transfer tax. This credit allows each of us to transfer up to $500,000 of Outpatient acute rehabilitation property ($600,00 after 1986) 2 during our lives or at death to anyone tax-free. New York has adopted the unlimited marital A residential program for persons deduction but has limited the unified credit to taxable estates of 3 with severe head injuries approximately $108,000 or lower. The marital deduction A day treatment center for persons and the unified credit can be maximized using a simple planning with moderate head injuries who technique. Assume that Dr. Ruth 4 require transitional living services owns $1,200,000 of assets jointly with her husband by operation of law. There is no estate tax because of the unlimited marital A community-based treatment center deduction. Her husband then dies for persons with mild head injuries one year later and the entire 5 $1,200,000 is subject to tax in his estate, resulting in a net Federal If your patient can benefit from one or more of these estate tax of approximately programs or if you want additional information contact: $190,000. (The New York estate 841-5849 for acute patients tax is not considered in this illustration). 845-1750 for community-based programs Now instead assume that Dr. Ruth's property was divided into two shares owned equally by the spouses as tenant in 8 1 1 S P II common. At Dr. Ruth's death, her ill w $600,000 share passes through herwill into a "unified credit trust” for her husband's benefit. The trust gives the husband income for JCAH REHABILITATION CENTER life and a trustee is appointed to and 407-Mrh Avenue S.F;. make discretionary distributions of CARF P.O. Box 1247 corpus to the husband. The trust accredited Puyallup. Washington 9S3?!-C1C'2

does not qualify forthe marital Providing physical rehabilitation for residents <>{ the Pjufic N nrtl.w st {nr over .’0 ve.m Continued on page 16.

1987 February The Bulletin 15 Estate Planning continued from page 15.

deduction, but the estate tax at Dr. qualify for a $10,000 annual Estate planning is not Ruth's death is wiped out by her exclusion from the transfer tax. A an exact science where the lawyer $600,000 unified credit. At the husband and wife can "split gifts" can feed numbers into a computer husband's death his estate only and quality fora combined and come up with a universal plan. consists of his $600,000 share of $20,000 annual exclusion. The Each doctor has different assets, the assets and the estate tax is exclusion is per donee, meaning, goals and problems and must eliminated by his unified credit. for example, that a doctor with 3 organize and plan his estate to The unified credit trust is not children and 6 grandchildren can arrive at a program that fits his included in his estate. By using transfer $180,000 out of his estate needs and philosophies. Doctors both spouses' unified credits, we tax-free each year. The transfers are not immune from the "pygmies" have saved $190,000 in estate can be made into trust or custodial which are lurking out there for us taxes. accounts of the beneficiaries are all, and you must make the time to There are other minor. plan for the inevitable. ------planning techniques available, but they require irrevocable lifetime 4. Short-term or Clifford tmsts: Ted H. Finkelstein, J.D., L.L.M., transfers of assets. These devices These trusts can shift income to Taxation, is the tax, trust and estate include. the lower tax brackets of parents or attorney at the law firm of Meiselman, children. The traditonal trust was Farber, Packman & Eberz, P.C., Mt. 1. The irrevocable insurance trust: fora 10 year period, but a new Kisco, New York. the doctor's insurance, preferably wrinkle called "the spousal term, is transferred to an reminder trust" can shorten the Reprint from Westchester Medical irrevocable trust with terms similar period. It must be noted that the Bulletin, fall, 1986. to the unified credit trust. By giving pending tax reform act is taking aim up the incidents of ownership of at eliminating this type of income the policy, the proceeds can be shifting device. removed from the doctor's taxable estate. In the case of a $1,000,000 policy and other taxable assets of $1,000,000, the tax savings from the trust will be o approximately $400,000.

2. The grantor retained income o trust (GRIT): This trust increases Medical Office Management the value of the unified credit by utilizing the IRS annuity tables. o Systems and Software The doctor makes an irrevocable transfer into a trust and retains the income from the trust fora period o M e d -P a k of years. He gives the principal to named beneficiaries, usually his children, at the end of the trust o "It will do w hat you w ant it to do!” period. The value of the retained 100% chance of success income interest is subtracted from the value of the gift, meaning that o "THE FUTURE" - (SOlflSWSRS the unified credit can be used to shelter transfers in excess of 321 Meridian S Puyallup, WA $600,000. For example, if the o Mon-Fri 10-6, Sat 10-5 doctor retains income for 15 years the $600,000 unified credit will 845-9673 shelter a transfer of $2,506,350. o Ovo 18 ye.irs experience in Medical Office The GRIT, however, is not a sure Mnricr-lenient to help solve your needs. bet; if the grantor dies within the income period the estate tax o l-eatunng Lpson Equity Series benefit will be lost.

3. Annual exclusion transfers: Transfers made during lifetime can o

16 The Bulletin February 1987 Can physicians play a vital role in nursing home care?

By Janyce Thomson, MN, RN

The Nursing Care following occasions: documentation and computerized Consultant role has existed for When facilities are decertified, data from the assessments more than twenty-five years and patient classifications are verified performed during the past year. presently carries out the states to ensure relocation to an These are used as a data base to utilization review responsibilities as appropriate facility or residence. evaluate the care and services outlined in the Federal provided and make Regulations. The State of When facilities request removal of a recommendations for Washington's Utilization Review Medicaid patient, to ensure such improvement. (UR) Program, approved by the transfer is appropriate. A social worker Department of Health and Human evaluates selected patients as well Services (DHHS) underwaiver When facilities terminate their as the provider's system to meet provisions of 42 CFR 456.505* Medicaid contract, to ensure social needs. The Nursing Care 508, has been in place since Sept. relocation to an appropriate facility Consultant and social worker then 30,1977. The Utilization Control or residence. conference with the providerto Program requirements, including share findings and make the Inspection of Care, are melded Historically, there recommendations to correct withthe UR system. The same have been few problems. Nursing home system is used for both skilled physicians interested surveyors, specialty consultants nursing and intermediate care and Nursing Care Consultants facilities. There are two hundred in the nursing home provide follow-up to ensure twenty-six dual facilities and thirty- patient. inadequacies are corrected. three free standing intermediate Coordination between care facilities. Twenty-two of the Documentation of all the Nursing Care Consultants and facilities are located in Pierce assessments are completed on the surveyors is ongoing and provides County. The four Nursing Care Client Profile and Interim Review direct exchange of relevant Consultants stationed in Pierce forms. Portions of this information and a routine sharing of County visit these nursing homes documentation are computerized IOC and survey reports, This as well as cover adjacent counties. and included in the State's Nursing working relationship is particularly The key elements of Home Information System (NHIS). evident in situations requiring the present system include an On-going monitoring is compliance enforcement assessment for all SNF Medicaid provided for all Medicaid patients in considerations and actions. patients within 30 days of nursing homes. This occurs both Exchange of information also admission and at least annually formally and informally. The occurs with Community Services thereafter. ICF Medicaid patients Nursing Care Consultant Offices (CSO) staff who have are reviewed every six months. responsible for each nursing home responsibility for placement and Additional assessments are makes weekly, bi-weekly or facilitation of relocation and accomplished based on monthly visits according to discharge as well a other programs established criteria and in worWoad, and is, therefore, within Aging and Adult Services response to specific events accessible for additional Administration. causing a significant change in the reviews/assessments or All Nursing Care patient's condition, care needs consultation as needed. Consultants are qualified and/or stability, perhaps Inspection of Care (IOC) professionals and are necessitating a change in the level reports are accomplished annually experienced, registered nurses, of care. for each Medicaid nursing home. with at least a baccalaureate Additional reviews are An accumulative report is written preparation. They are trained to accomplished, if necessary, on the utilizing observations, Continued on page 18

1987 February The Bulletin 17 Physicians role in nursing home care continued from page 17. work with long term care facilities readmissions when in the best requirements. Medical directors of and geriatric patients, and are interest of the patient. facilities, in some instances, have geographically located in CSO's While utilization review been reluctant to contact the throughout the state to maximize must remain the primary focus of attending physician when paper their availability to facility staff, the program, the role of patient compliance and other care issues patients, financial and case service advocate in securing care and needed to be addressed. workers and families of patients. services for the medicaid client Physicians can become Each nurse carries a caseload of gives the most satisfaction to the a vital part of improving care approximately ten nursing homes Nursing Care Consultants. In facilities. Not only by continuing to with 550 to 600 Medicaid patients. pursuing this activity, they interface follow their patients when placed in Supervision is provided by masters with a number of disciplines, nursing homes but by offering their prepared professional nurse including physicians. expertise in inservice programs, section managers. Historically, there have giving suggestions in upgrading The Nursing Care been few physicians interested in care and by becoming involved Consultants only review patients in the nursing home patient. medical directors. the nursing home. Assessments However, the last few years has There is a need for prior to placement are carried out produced a trend towards a greater physicians to gain more by Community Nurses employed in number choosing Geriatrics as a understanding in areas of the Community Services Offices specialty and willingness to rehabilitation and restorative (CSO), who use Nursing Care participate in nursing home nursing, discharge planning and Consultant classification criteria to programs. community alternatives to nursing designate a level of care and One area of concern is home care. Nursing Care ensure proper placement. that physicians have been Consultants are just one resource Level of care reluctant to complete paperwork to when seeking this information. determinations in skilled nursing meet federal regulations, even Professional nurses in nursing and intermediate care facilities are though the American Medical homes and hospitals, discharge made by the Nursing Care Association was very involved in planners, CSO placement workers Consultant's professional the formulation of these judgement based on classification Continued on page 19. criteria and in accord with state and federal regulations. The reclassification procedure requires rigid adherence to specific time frames and regulations governing the patients right to appeal the decision. The procedure includes written notification of the physician if the patient is to be relocated and an opportunity to provide additional information within fifteen Puget Sound Collections Inc. days. The exceptional care Endorsed by the Medical Society rate program is also carried out by of Pierce County Nursing Care Consultants. To Professional collection services facilitate placement of the heavy to the medical community since 1960. care patient from the hospital, a benefiting all Medical Society Members. review is done to set a special rate. This rate is based on the number of Mem te r American Celle'-tors Association hours of required direct nursing Medical.-Penial Hor.piloi Bureaus ol America care. The process also includes David Michaud, patients already residing in a General Manager nursing home. Nursing Care Consultants and Managers are Puget Sound Collections Inc involved in the Compliance Enforcement Committee. They monitor the ongoing care of patients in facilities under a stop placement order and approve

18 The Bulletin February 1987 Physicians role in nursing home care continued from page 18. and other Adutt and Aging Services Administration DIAPER RASH1 employees are also good s 4 t(ten. IS NOT A WAY OF LIFE resources. fa te o d t You can recommend professional This opportunity to ocviyetty diaper service with confidence. describe the Nursing Care Consultant Program is appreciated. • Laboratory Controlled. EdC h month a random sample of our diaper? is Please contact us if you have U4. subjected 10 exhaustive studies in a questions/problems with the biochemical laboratory. program or individual patients. Union Avenue Pharmacy • Utmost Convenience. Thanksto pick Janyce Thomson, Supervisor of & Corset Shop up and delivery service, our product Nursing Home Consultants was asked 2302 S. Union Ave„ Tacoma comes when y ou need it. to submit an article to The Bulletin 752-1705 • Economical. All this service, all this outlining the role of the Nursing Home protection against diaper rash c o sts Consultant in the nursing home by the far less than paper diapers - only Committee on Aging.------pennies more a day than home- washed diapers.

Pierce County CAUTION TO YOUR PATIENTS. II is illegal to Nursing Care dispose o1 human excrement in garbage Computerized Testing Parents are doing this with paper/plastic Consultants By F astest diapers. "Disposable" is a misnomer. Ethel Flynn, BSN, RN Psychological. Vocational, Baby Charlotte Behrle, BSN, RN Educational Diaper -phone592-2013 Adult and Childi'on Marion Wilson, BSN, RN service Jane Castro, BSN, RN Harold B. Johnston, MD, P.S. TACOMA WA TOLL FREE -phone 593-5474 Allemnore Medical Center, B-^OI)9 383-BABY 1-800-562-BABY South lf)th & Union Section Manager: Washington's Oldest, Most Trusted Tacoma, WA M-405 Professional Diaper Service i- Janyce Thomson, MN, RN- phone Telephone 383-2413 I I Serving Our Second Generation P T 1-586-0162

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18 The Bulletin February 1987 Looking Back... Bridge Over Troubled Waters

By Mavis Kallsen

During the year of logging camps, and she worked as their own doctors, but this never 1905, the undercurrent of a cook in order to send him on to happened. First-aid crews in the dissension within the Medical the University. He earned his old camps could apply splints and Society of Pierce County over degree in medicine at the administer whiskey, and the boss contract practice reached University of Vermont in 1904. of that crew was called "doc," but turbulence. Dr. C.E. Case was Bridge's first task in the first-aid crew was usually the rocking the boat on the choppy Eatonville was to raise capital for a fire-crewtoo, and in the event of an waters of fraternal love in the hospital. Besides his medical accident they were primarily Society, and it was about to practice income, he picked up a interested in putting out the fire. capsize. But out in the boondocks few dollars delivering telegrams on The closest thing the camps had to of Pierce County a young doctor his bike for a fee of f ifteen cents having their own doctor was Albert envisioned a medical empire that each, and he sometimes drove the Bridge. would make him rich and famous, supply wagon for the general At the time when the and he was already constructing store. In three years he had saved Tacoma hospitals were forced to the span over these troubled enough to buy a small frame give up their medical service waters...an organization that would cottage and convert it to an contracts by action of the Medical provide total prepaid health care emergency hospital. His first Society of Pierce County, Albert with or without the sanction of the employee was the beautiful Bridge contracted for complete Medical Society of Pierce County. Genevieve Carson, newly service forthe loggers with several The summer of 1904, graduated from Saint Joseph's improvements on the basic idea...it the young Doctor Albert Bridge school of nursing. was his hospital, and it was located arrived in Eatonville pushing his The intensity of the where it oculd be most useful. bicycle. He had pedaled up from young Doctor Bridge’s ambition Bridge's Eatonville General the train station in Tacoma with all was no less than the compulsion Hospital was an immediate his worldly goods, mostly surgical Genevieve herself had toward success. tools and drugs, packed on his achievement in the field of As highball logging in back. Two miles out of Eatonville medicine. Fun-loving and spunky, the Eatonville area reached fever he'd had a flat tire, and hiked with the beautiful Genevieve was the pitch, the hospital became the his bike the rest of that dusty road Doctor's counterpart in nursing, center of activity in town. Albert through the woods. ToNels and blazed trails of her own in a Bridge added motorized Christianson, who operated the long and successful career. She ambulance service, hired another general store in Eatonville, he once fought off a pack of dogs in doctor to assist him and branched confided it was his ambition to the dead of night in the streets of out with an auxiliary hospital at "become a millionaire here." Eatonville, over an amputated leg Morton. Albert Bridge was no the dogs had carried off from the In addition to the stranger to the woods, having hospital. industrial contracts he held, Bridge been born in a logging camp in Up to that time loggers decided that the community itself Vermont. seriously injured in the woods needed a cheap medical service of When he was twelve his father was around Eatonville were brought high quality. He devised a means killed in a logging accident, and into Tacoma hospitals in "drays," to render this sen/ice and still make the family moved to town where usually crude wagons used for money at it, by selling "hospital Albert atte nded school for the first hauling supplies to the camps, or in tickets" to individuals not covered time. He proved to be such a "crummies" hauled behind log by the industrial contracts. It cost a bright and able student, his mother trains. A common error in bachelor one dollar and a married insisted he continue his schooling northwest history books is that man a dollar and a quarter a month instead of going to work in the logging camps sometimes had for full health care coverage.

20 The Bulletin February 1987 Looking Back continued from page 20.

Children of the insured were substantial tile building on the main the second round the logger had treatedfree! street of town, with his offices and blacked both Bridge’s eyes and Down in Tacoma, where drugstore on the first floor and the broken his nose, and the referee Doctor Yocom had a substantial hospital and laboratories upstairs. stopped the fight. monopoly on industrial medicine The management of the hospital The Pierce County contracts, the inroads Bridge was largely Genevieve's Industrial Medical and Surgical made on the logging contracts responsibility. Bureau was organized by the were viewed with alarm. Yocom Just before World War I, Medical Society of Pierce County persuaded his former associate, Bridge decided to expand his in 1917ostensib!yto provide first- Doctor Thomas Curran, who had services to the other side of the aid care in industrial accidents. It been logging the Everett area for mountains and sent Genevieve to preceded the State Industrial about five years, to return to operate a hospital in ElJensburg. Insurance Act by six years, and was medicine. The two then formed The project was unsuccessful considered a form of Bolshevism in the incorporated Yocom and when Genevieve met and married medicalcirclesnationwide. By Curran Clinic which was later an insurance salesman and moved contracting with industrial groups, renamed the Western Clinic. But it to Spokane. The marriage proved the physician members of Ihe was another decade before Yocom unsuccessful too, and Genevieve Bureau had in fact entered the field and Curran extended their returned to Tacoma to head the of contract practice themselves, contracts to cover the families of nursing staff of the N.P Hospital. but continued to oppose contract the insured workers or made She never again was employed by practice outside the Bureau individual contracts as Albert Albert Bridge, but as their careers relentlessly. Bridge did. paralleled in Pierce County, they In 1923 Albert Bridge Doctor Bridge made remained very close friends. moved his headquarters to regular rounds of the logging When World War I Tacoma, with a clinic and offices in camps to check on health began, Doctor Bridge was both the Fidelity Building, maintaining conditions. This was in a day when town mayorin Eatonville and the hospital at Eatonville with access to most camps was by chairman of the school board. He Doctor Wiseman in charge there. railroad, in which case Bridge was also chairman of the local Red With the passage of the Industrial worthed a handcar, or by hikes over Cross, which was assigned a quota Insurance Act, contracts forthe skid roads. He sometimes of $1,000 for war relief. To help medical care of teachers and public performed minor surgery on these meet the quota, Doctor Bridge employees were up for grabs, and camps visits, and young staged a boxing and wrestling Bridge won them. He later won the Genevieve often accompanied the smoker in town hall and he himself huge teamsters contract in fierce Doctor on these forays for days at a stepped into the ring with a young competition with the Pierce County time. logger as his opponent. It was a Medical Bureau and the Western Eatonville became a great event forthe Red Cross Clinic. medical center for the togging fund, with receipts totaling over By 1930 Albert Bridge community. Bridge built a nineteen hundred dollars, but by had buitt his medical empire, with Continued on page 22.

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1987 February The Bulletin 21 Looking Back continued from page 21.

over 14,000 contracted patients in War II caused a shortage of doctors of his estate to Genevieve. When Pierce, Pacific and King Counties. he worked harder than before, Genevieve learned this, she He then built the modern hospital slept at the hospital and often saw convinced Bridge’s attorneys that complex on Market Street which overtwo hundred patients a day. she wouldn't accept the later became Doctor's hospital and He was on call at all times for inheritance, and finally persuaded is now part of Multicare. He emergencies and, aside from his Bridge that the money should go continued to wear plaid shirts and professional associates, saw few to establish a much needed logger's boots and was considered friends, other than the still- hospital for children here in a curiosity at the Country Club, but beautiful Genevieve. He financed Tacoma, honoring his mother, Mary he was much admired by the her purchase of the Puyallup Bridge. business community, and he had Valley General Hospital, and Albert Bridge has the biggest business of any doctor Genevieve managed a return on spanned the turbulent times of in Pierce County. In those years, his investment. acceptance of the prepaid health as his friend Valen Honeywell later Shortly after the war care concept, and his hospitals recounted,"He played as hard as ended, Bridge's health failed, and may live to see something else. he worked, and he hated to be he became a patient in his own beaten even in a simple game of hospital forthe last four years of his "Bridge Over Troubled Water," by cards." life. Mavis Kallsen, first appeared in The In 1933, the King Bridge had amassed a Bulletin, County Society organized their sizeable fortune, and he instructed own physicians' service patterned his attorneys to bequeath the bulk after the Pierce County Medical Bureau, and almost immediately took steps to rid themselves of competitors in their area, namely, Curran's State Clinic there and the Bridge Clinic, who had been providing prepaid health care in King County for years. The president of the King County Presenting The Pacific Society personally charged Curran and Bridge with an assortment of Northwest s First Regional violations, and the politics of the Seminar On Gerontological Nursing time being as they were, the Medical Society of Pierce County March 25, 26, 27 complied with their own litigation against their two members, For the first time, more than 30 of the Pacific Northwest's charging them with "misconduct as leading specialists in the field of geriatric care join in a physicians and as citizens." The proceedings which symposium aimed at making nurses and other health-care pro­ followed can only be described as fessionals more expert in caring for the elderly. grotesque, and the outcome was Headed by Richard Waltman, M.D., FAC.P. this intensive pro­ that both Curran and Bridge were gram explores the aging process and its effect on body systems. expelled from the Medical Society Attendees will be eligible for IS CHRP credits. For an informa­ of Pierce County. As Tom Murphy, tive brochure about the seminar, write or call: Sr. recalls, "It was a battle, and in taking Bridge's side in the skirmish I Humana * Hospital-Tucoma was almost thrown out too." Nursing Administration Non-members of the I’.O. li(i\ l l-tl-j medical fraternity, both Curran and Tacoma, WA 98411-tHH Bridge continued to provide tow- (2f:i cioclor.svl Albert Bridge was planning to retire, but when World

22 The Bulletin February 1987 The following commentary along with the accompanying poem was submitted by a member, thinking it applies to many of us. The Editor Are you picking enough daisies?

Even for a successfully practicing physician, life is-or should be-more than medical practice. The old man's poem below asks whether you are keeping things in perspective

despite the natural pressures for professional and financial" success."

I read this poem a few months ago, and it has remained prominently on my desk every since. In addition to governing some of my thoughts each day, it makes me think about some of my clients and friends. 1 particularly wonder how l- and my acquaintances-will sit back and evaluate our lives when we’re 85. Medical practice becomes such an all-consuming activity. So many doctors I know run week after week from office hours to hospital duties to meetings to night call, breaking the routine only a few weeks a year--often oriented to professional and educational seminars. The center of these doctors' universe is their hospital and their professional status within it. Their families and other interests get whatever time and attention may be left over. Most of these doctors are financially successful, but they seem forced to maintain an income level which is far above what they anticipated in their youth. There seems to be no way off the merry-go-round of practice demands and personal financial commitments. They're locked into their lifestyles. My saddest consultation was with a surgeon contemplating retirement from a fine group practice. He told me he'd never had or taken the time to be active other than in medicine, and now he feared the loss of his one activity upon retirement. It may have been too late for him--and many similar doctors-to pick more daisies.' How about you? Are you balancing medical practice and life's other features? Here's the poem:

I'd Pick More Daisies By Ray Lucht (85 years old at the tim e). Reprinted from the North Carolina Medical Journal

I f I had my life to live over, I'd try to make more mistakes next time. I would relax. I would Umber up. I would be sillier than I have been on this trip. I know of very few things I would take seriously. I would be crazier. I would be less hygenic. I would take more chances. I would take more trips. I would climb more mountains, swim more rivers, and watch more sunsets. I would burn more gasoline. I would eat more ice cream and less beans. I would have more actual troubles and fewer imaginary ones. You see, I am one o f those people who lives prophylactically and sensibly and sanely, hour after hour, day by day. Oh, I have had my moments. And, if I had it to do over again. I ’d have more o f them. In fact, I’d try to have nothing else. Just moments, one after another. Instead of living so many years ahead o f each day. I have been one of those people who never go anywhere without a thermometer, a hot water bottle, a gargle, a raincoat, and a parachute. If I had it to do over again, I would go places and do things. And travel lighter than I have. Ifl had my life to live over, I would start barefooted earlier in the spring. And stay that way later in the fall. I would play hooky more. I wouldn't make such good grades except by accident. } would ride merry-go-rounds. I'd pick more daisies.

* Also appeared in The Physician's Advisory. Dec., 1986.

1987 February The Bulletin 23 Medical Society/Madigan Army Medical Center

ANNUAL JOINT MEMBERSHIP MEETING

"What's Happening to CHAMPUS" Lt. Col. William Cahill

DATE: Tuesday, Feb. 10,1987

TIME: Cocktails 6:15 P.M. (No Host) Dinner 7:00 PM. Program 7::45 PM.

PLACE: Fort Lewis Officers' Club (Pass thru 4th traffic light, turn right on Bifar)

C O S T : $12.75 per person (includes gratuity)

Register now. Space will be limited. Please complete the attached reservation form and return it, with a check for the appropriate amount made payable to the Fort Lewis Officers' Club, in the enclosed pre-addressed envelope, or call the Medical Society office, 572-3667, to confirm your attendance.

Dae to the special arrangements necessary for this joint meeting, reservations must be made no later than Friday, February 6.

REGISTRATION Yes, I (we) have set aside the evening of February 10 to join my fellow Society members and physicians from Madigan Army Medical Center at the annual Joint Meeting.

______Please reserve______dinner(s) at $12.75 per person (gratuity included).

Enclosed is my check for $______. (Payable to Fort Lewis Officers' Club).

______I regret I am unable to attend the dinner portion of the meeting. I will attend the program only.

Dr.______

RETURN TO MSPC NO LATER THAN FRIDAY, FEBRUARY 6.

24 The Bulletin February 1987 follow. Tickets may still be The program will feature Pierce County available from Karen Dimant at 851 - "Women in Sports," a collection of Health Fair: Feb. 9404. 33 costumes, each hand made. 13,14,15. Authentic outfits from ancient Auxi Quad Greece up through the present will be modeled, as the narrative Brunch: Feb. 20. follows the emergence of women The Pierce County to freely participate in various Health Fair is scheduled for Feb. sports activities. This collection 13,14, and 15 at the Tacoma Mall. What's special about was created by a non-profit, 11 you can spare a couple of hours the years that end in odd educational committee in Olympia during any of these days and help numbers? The Auxi Quad Event, to commemorate the Women's do blood pressure checks at the of course! Once every two years Marathon Trials held in Olympia, it Auxiliary booth, please call Sally the Auxiliaries of the Medical, will ultimately be donated to the Palm-Larson at 588-9839. Dental, Legal and Pharmacy State Capitol Museum for professional Societies traditionally permanent display. Fashion Show: join together for friendship and Please reserve with March 18. fun. Ruth Jackson, 7510 87th Ave. The Auxi Quad brunch SW, Tacoma98498. Yourcheckis for I987 will take place Fri., Feb. 20, your reservation. Guests are The Fashion Event and attheTacomaDomeHotel. The welcome. Early reservations are Show sponsored by the PCMS social time begins at 10:00 a.m., recommended, as four different Auxiliary, the Tacoma Junior with the brunch at 10:30 a.m. The groups are involved and a large League, the Tacoma Orthopedic buffet style feast will include shrimp attendance is anticipated. Please Guilds and the Tacoma Stars will be newburg, chicken cacciatore, and call Ruth at 581-7357 or Debby held, Wed., March 18inthe blintzes, in addition to ham, McAlexander at 588-1013, should Tacoma Dome. scrambled eggs, and otherbrunch you have any questions. Pre-events begin at 10:30 a.m. fare. The cost is $12.00, including with luncheon and fashion show to tax and gratuity.

Graduating Seniors

The Auxiliary would like to recognize all graduates this year. If you have a son or daughter graduating from high school, vocational school, college, graduate school, etc., please take a moment to fill this out and return it to the Medical Society Office, or Margie Ritchic, 4803 95th Ave., W., Tacoma 98467, by April 1.

Students N a m e ______

Parent's Name______

Graduating From______

Degree or Diploma Received

Future Plans

1987 February The Bulletin 25 Classifieds

Physicians Needed hospitalization, diagnosis or special Downtown Medical Suites • treatment recommendations and Newly remodeled, improvements to clinical consultation to Center staff. tenants needs. Individual suites and Primary Care Physicians - Qualified applicants may submit shared offices. Parking available. Excellent practice opportunities resume to CMHC, 1201 So. Proctor, Reasonable rates. 383-5500/565- immediately available for outstanding Tacoma, WA 98405. EOE. 4444. BC/BE family, general and internal medicine practitioners. First year ENT Physician - Outstanding income potential to $80,000. Office Medical Equipment practice opportunity available for full­ space and marketing support provided time, board certified for those eager to build a strong Modern Medical Equipment - In otorhinolaryngologist. Fully equipped practice in a supportive medical excellent condition for sale. Practice and furnished office located in prime environment in metropolitan Seattle. closure. Midmark power table, FPS-3. medical office building with established For more information, phone or write, Fiber optic sigmoidoscope, Hamilton referral network. Office space and include C.V.; Recruitment Committee, Premiere exam table, Burdick EK5 marketing support provided for West Seattle Community Hospital, Defibrillator, treadmill, heart monitor, selected physician eager to quickly 2600 South West Holden Street, etc. Call 572-7474 or 531 -0181. build an active practice. Mail C.V. and Seattle, WA 98126, (206) 938-6000. tetter of professional goals to "Medical Surplus Medicai Equipment - Staff Specialist," 1906-D, S.W. 318th Pediatrician Wanted - Seattle area. Large inventory of diagnostic, office Place, Federal Way, WA 98023. Full time, also possible part timer. and home care equipment. Prices Group of five. Send C.V. and extremely reasonable. Call Lynda availability date: Children's Clinic, Wanted Retired Cardiologist - (206) 453-8892. 2161676th Ave. W est#108, for part-time research work at Blood Edmonds, WA 98020. Pressure Research Clinic. Washington license required. Call 357- Medical Director Position - 6689 or write Blood Pressure Research Providence Medical Center in Seattle Clinic, 140 N. Percival Street, Olympia, is soliciting applications for the WA 98502. position of Medical Director. Applicants interested in further Committed Family Practice information concerning job description Physician - Needed by urban Native and position qualifications should American community for challenging contact either Peter Bigelow, and fulfilling practice. Excellent Administrator at Providence Medical medical community, ideal location with Center, orGerold F. Garrett, MD, MEDICUS nearby mountains, beaches and Cleaning Seruice Chairman of the Medical Director cultural activities. Good benefits Residence & Private Offices Search Committee. Inquiries to either package. Send CV: Puyallup Tribal of these individuals should be directed Health Authority, 2209 East 32nd to Providence Medical Center, 500 • Street, Tacoma, WA 98404. 17th Avenue, Seattle, W A 98124. (206)565-9317 Eva Oravetz 5503 39th C .E . Tacoma. WA 98466 F.T. Position in Tacoma Clinic - Also P.T. Hourly rates plus Office Space malpractice. Flexible scheduling. Any state license. Other opportunities. Office Space - In-office lab and X- Call NES 1 -800-554-4405. Ray facilities to share with two sub­ specialists in the Cedar Medical Looking for Doctor - Share office Center, rent with option to buy. 1901 space in 3,000 sq. ft. medical clinic in So. Cedar, Tacoma, 272-2261 or 572- Puyallup, 1-5 days per week. Call Dr, 3520. Advertise in the Charochak, 848-5555. Ideal Lease Package - For Classifieds Psychiatrist ■ Full time or part time specialty practice or team. contractual position available with Immediately available: 1754 sq. ft. in For Rates contact Sue Asher Comprehensive Mental Health Center. contemporary office near hospital. Membership Benefits, Requires board eligible psychiatrist LBtiSlId-. South Seattle. 1-206-244- Medical Society of Pierce with completion of three-year 3915. residency in psychiatry, licensed to County practice medicine in the State of University Place Professional Washington. Responsibilities include Square - Medical Center. Improved client evaluation for medication. suites at reasonable rates. 565-4444. 572-3709

26 The Bulletin February 1987 PHYSICIANS

Your Army Reserve Personnel Counselor would like to talk to you about the following opportunities in the US Army Medical Department:

PART-TIME INCOME CONTINUING MEDICAL EDUCATION RETIREMENT POTENTIAL ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOR BY THE US ARMY RESERVE

Major Paul H. Lawhon, MSC 206-967-5046

Many groups TALK about building a better America- The Arm y Reserve WORKS at It.

PHYSICIANS INSURANCE

ASSETS POLICYHOLDERS PREM fCM S Physicians Insurance was created in 1981 w ith th e following g oals:

• Quality Protection • Dividend Sewings • Superior Service • Aggressive Defense • Selective Underwriting % Low Administrative Costs • Physician Input and Control

With these goals in mind, Physicians Insurance has become the largest underwriter o f Professional Liability coverage in the state. To determine if you qualify for coverage or to request additional information, contact: Tom Fine, V.P Physicians Insurance 2033 Sixth Avenue Seattle. WA 98121 (206) 728-5800 1-800-732-1148 MEDICA1. SOCIETY OF PIERCF. COl'NTY BULK RATE 705 South 9th, Suite 203 U.S. P0S,f'A,CE T aco m a, Washington 98405 n r , P iL K v t cCIUIMI r MEDICAL LfBPARY PAlb' ADDRESS CORRECTION Kt'OlES'IKD p f{ R r | y . 3 0 7 7 TACOMA. WASH

PERMIT NO. 60S TACOMA WA 98405 Consider the causative organisms

cefaclor 250-mg Pulvules t.i.d. offers effectiveness against the major causes of bacterial bronchitis Haemophilus influenzae, H influenzae, Streptococcus pneumoniae, Streptococcus pyogenes (ampicillin-suscepfible) (amptcillin-fesistant)

Note Ceclor" is contraindicated in patients with known allergy Penicillin is the usual drug of choice in the treatment and to the cephalosporins and should be given cautiously to penicillin- prevention of streptococcal infections, including the prophylaxis allergic patients. of rheumatic fever. See prescribing information.

C eclo r ice la d o O associated diarrhea Colon llora is aliered penetrates mothei s milk txercrse • Cases of anaphylaxis have been reported, by broarl-simclium antibiotic liealmenl Summary. Consult Ihe package literature caution in prescribing lor these patients ball ot which have occurred in patienls possibly resulting in antibiotic-associated for prescribing information Adverse Reactions: ipeieentage ol with a history of penicillin allergy. c o litis • Olhcr eosmophilia. 2%. genital pruritus Indications Lower respirator/ infections patie n ts.i including pneumonia r.au.selfliv sus Precautions I herapy related adveise reactions are or vaginitis, less than 1% cepnnle olr.iinb of 'Jlfp-pWcocuio piwu • Discontinue Ceclor in the event nl uncommon Those repotted include Abnormalities in laboratory results ol aileron reactions to it mumao H;iemt>phihir, mHup.n/ne and • Gaslnimtestmal (mostly diairheaj 2.5% uncertain etiology •:> 'U O iup A he I a - ho m o l y 11 c • Prolonged use may resnll m overgrowth •Sympiorns ol pseudomembranous • Slight elevations in hepatic enzymes. nl nnnsusceptible organisms colitis may appear either durinri 01 after • Transient fluctuations in leukocyte • Posilive diffjr:! Coombs tests have aindicaiions Kri antibiotic treatment count (especially in inlants and children) been lepnMerl during irn.ilmeni wilh • Hyoersensitivity reactions (including ■ Ahnoimal urinalysis, elevations in BUN M:(ifl.ilOci|l!)(ltlS '.H iU J L fi B l A D V iIFJ mnitnlliloim eiuptions. pruritus, urticaria nr serum creatinine ■ lii renal irnpaumerii sate dosaoe ol 'i 11)' 4 '{ 10 I'ENIOH I IN erythema multitorme. scri.im-sickness- • Positive direct Coombs' lest Cecloi may he lower than thal usually like re a c iio n s ) 1 5% usually subside • False-positive tests lot urinary glucose r>;r-omnif*nf|Pfl CerlO! -ihrjulrJ be admin­ within a lew days alter cessation ot with Benedict's or Fehting's solution and istered with i.julm ri in such p.ilienls i < i'-n.1^1 F- therapy Miese reactions have been Clm itcst' tablets but not with Tes-Tape' • h.-.a;! spi'Umm .uitilm'itu Should tie roriorind morn Ireiiuuritly in children (glucose enzymatic test strip, Lilly) ::m!';i.:iiIiitI Aiilh r.iutinn in ini tja r;rr>.11n Ir*s 11nnI rluriof] or following a second course ol r.-jrtu-ijI.-iMv r uliti: Am tmM lolmmMm available m Otc therapy with Cecloi No serious sequelae iw/psiicw? ori n'QiXSI ton f h I # Mtl • s .ilc W anrr c lfc c ti'/rin o 1.''. h,ive ri-H N t h have herni repoiled Antihistamines C m y w Mi,moohs Indiana 4G285 iii-i^irmrnjii in iirijfjiianr.y. I.iaation .inn arif) ciirticosioioid;; aopoai 10 e nhance Ell Lilly Industries, Inc. m l,in i' If:*;* than im e rm ritli C o rlf.i f'- .iiiiihon ut ihe syndrome Carolina, Puerto Rico 00630 MSPC^ I . U \ 1 \ ■ ■ > j

j - ' - j ; r ' r7 * A publication of the Medical Society of Pierce County

V O L . 2, N O . 2 705 S o u t h 9th, Suite 203 MARCH, 1987 Tacoma, Washington 572-3667

SOCIETY’S CONTRIBUTION DIRECTOR OF DSHS TO TO C.O.M.E. Factors impacting allied ADDRESS DOUBLED health programs were: GENERAL MEMBERSHIP MEETING Due to the financial crisis 1) Withdrawal of mandatory March 10 the College of Medical continuing nursing educa­ Education is experiencing, tion for relicensure. Jule Sugarman, Director, the MSPC Board of Trustees 2) Hospitals development of DSHS will address the March voted to double the education departments to 10 general membership Society’s annual contribu­ coordinate conferences tion ($6,776) to the originally managed by the meeting to be held at the College of Medical Educa­ College. Fircrest Golf Club. tion. 3) Marketing of nursing inservice education by Mr. Sugarman has been The Board passed a Resolu­ hospitals for a very low asked to address such tion urging similar action enrollment fee to other Issues as; by the Pierce County hospitals. Medicaid reimbursement Hospital Council. The 4)Less education funding policies, Child Abuse, College is supported by available to hospitals and AIDS contributions from the 5}Hospitals charging for Uncompensated Care, Society (55%), the Hospital the use of room space for Nursing Home Care and the Council (45%) and registra­ meetings at the rate direction Mr. Sugarman and tion fees. equivalent to the local the administration is hotels. going with the Department.

See page 10 for a regi­ stration form. C.O.M E DROPS ALLIED HEALTH PROGRAMS

As a result of several factors, the College of TRIAL DELAYED TO SEPTEMBER Medical Education will not 21 be planning allied health programs except on a Originally scheduled for contract basis. In 1986 January 12, the lawsuit Dr. the College realized only Scott L. Havsy has filed one-third of its projected against the Medical Society budgeted income from allied and Good Samaritan Hospital health programs and has has been rescheduled to required an infusion of WAMPAC begin September 21, financial aid from the Medical Society and Pierce County Hospital Council.

MSPC NEWSLETTER 1 MARCH, 1987 PHYSICIANS NEEDED

F.T. Positions in Tacoma Clinic. Also P.T. hourly rates plus malpractice. Flexible scheduling. Any state license. Other opportunities. Call NES 1-800-554-4405.

Private practice opportunity available for part-time Board certified/eligible Orthopedic Surgeon in the beautiful, rural community of Morton, southwest Washington state. Financial potential histories available. Practice located in an excellent, new clinical facility situated adjacent to 20-bed Morton General Hospital, which is affiliated with Virginia Mason Medical Center in Seattle. Excellent outdoor recrea­ tional opportunities. Send C.V. to: Patty House, Health Resource Services Group, Virginia Mason Hospital, 925 Seneca, P.O. Box 1930, Seattle WA 98111, (206) 223-6351.

Committed Family Practice Physician needed by urban Native American community for challenging and fulfilling practice. Excellent medical community, ideal location with nearby mountains, beaches and cultural activities. Good benefits package. Sent CV: Puyallup Tribal Health Authority, 2209 East 32nd St., Tacoma, WA 98404.

OB/GYN for Pacific Northwest, beautiful country setting, easy access to urban amenities. Eight person group seeks second OB/GYN for rapidly growing, low-risk practice. Family oriented community near major urban area, 60 minutes from outstand­ ing ski resort. For information call or send CV to: The Friedrich Group, Inc., 9284 Ferncliff Northeast, Bainbridge Island, WA 98110, (206) 547-7850 or (206) 842-5248.

PEDIATRICIAN WANl'iiP - SEATTLE AREA. Full-time, also possible part timer. Group of five. Send C.V. and availability date: Children’s Clinic, 21616 - 76th Ave. W. #108, Edmonds, WA 98020.

EOT Physician - Outstanding practice opportunity available for full-time, board certified otorhinolaryngologist. Fully equipped and furnished office located in prime medical office building with established referral network. Office space and marketing support provided for selected physician eager to quickly build an active practice. Mail C.V. and letter of professional goals to: "Medical Staff Specialist," 1906-D S.W. 318th Place, Federal Way, Washington 98023.

POSITION WANTED

Board Certified general internist, 40, seeks practice opportunity in the Tacoma area. Group arrangement preferred. Would also consider summer or full year locum tenens or practice swap (Northern California). Reply to: Physician, P.O. Box 927, Healdsburg, CA 95448.

MEDICAL B&JIR1ENT

Surplus Medical Equipment. large inventory of diagnostic, office and home care equipment. Prices extremely reasonable. Call Lynda (206) 453-8892.

MSPC NEWSLETTER 2 MARCH, 1987 senator Jim McDermott. STAN TUELL HONORED NO SMOKING RESOLUTIONS introduces Senate Bill PASSED BY 5781 Over 200 friends, col­ BOARD OF TRUSTEES or Initiative #92 leagues and relatives turned out on January 15 to Two resolutions concerned Senator McDermott, Chair­ honor Stan Tuell for his with smoking were adopted man, Senate Ways and Means many, many contributions to unanimously by the MSPC Committee met and heard the people of Tacoma and Board of Trustees at its testimony on Senate Bill the Medical Community. February 3 meeting. 5781 February 18 as the Newsletter goes to the "This Is Your Life", a The Board voted to printer. replay of Stan’s life PROHIBIT SMOKING AT ALL through comments by friends MSPC SPONSORED MEETINGS The legislation, which and relatives sis the crowd and to URGE ALL MEMBERS TO would mandate Medicare enjoyed viewing slides of PROHIBIT SMOKING IN THEIR Assignment came as a Stan growing up in Tacoma, OFFICES. (Meaning the work surprise to WSMA’s legisla­ on to medical school at area as well as the tive team. Senator Northwestern to return to patient waiting room.) McDermott had not indicated Tacoma and serve his that he would support such community in many ways. legislation. It was a memorable evening MSPC’s legislative phone for all who attended. tree, a product of Sharon Ann Lawson’s efforts went Stan graduated from DOCTORS ’ EXCHANGE to work calling members of Northwestern University RECEIVES MBI the Auxiliary urging calls Medical School. He ENDORSEMENT to Senators Gaspard, completed his surgical Rasmussen and Wojahn residency program in 1952 The MBI Board of Directors members of the Ways and and began his practice in unanimously voted to Means Committee. The Pierce County in April endorse The Doctors’ senators were requested to 1953. Exchange, a locally owned not pass the bill out of and operated answering committee. He served as President of service. the Medical Society in 1963 The position of WSMA on and has served as president The Doctors’ Exchange has the legislation is that it of virtually every hospital been answering phones in is a federal issue and and organization to which Pierce County since 1938 should be resolved at the he has belonged. His and has recently upgraded federal level. Legis­ record stint as Speaker, their equipment to enable lators are being asked to House of Delegates, WSMA them to serve physicians let the Initiative go the for 17 years is unparal­ with the latest state-of- the public for a vote in leled. the-art equipment. the election of November, 1987. Multicare presented Stan If you would like a tour and Stephanie two bicycles of their facilities for a Every effort will be made to enjoy in their retire­ greater understanding of to keep you abreast of the ment. Stan also received a the company’s capa­ issue in Olympia. Now is solid brass gavel in bilities, please call the time to learn who your recognition of his skills Scott Hager, Doctors’ legislator is and his/her as a parliamentarian (one Exchange, 272-4111 or Sue phone number. If you are of 31 registered parliamen­ Asher, MBI, 572-3709. uncertain, call the Society tarians in the State) and office at 572-3667. Your two jars of Adams Peanut calls can make a difference Butter. in the way a vote can go.

MSPC NEWSLETTER 3 MARCH, 1987 OFFICE SPACE

Office space with in-office lab and x-ray facilities to share with two sub-specialists in the- Cedar Medical Center, rent with option to buy. 1901 South Cedar, Tacoma, 272- 2261 or 572-3520.

Professional offices for rent. Advantages: good parking, close to hospitals, minimal rents, lab and x-ray in building. Call Dr. Moosey, 383-1717 or 383-1718.

Looking for doctor to share office space in 3,000 sq. ft. medical clinic in Puyallup, 1-5 days per week. Call Dr. Charochak, 858-5555.

SEMINAR

A bio-ethics seminar sponsored by The Physicians for Moral Responsibility will be held April 4th at the Sheraton Hotel, Tacoma. For further information, write to Dr. Gentry Yeatman, P.O. Box 98257, Tacoma 98498.

Crossroads Treatment Center ijjF THE DOCTORS’ EXCHANGE Alcoholism i SINCE 1938 A Program Designed to Provide ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY Comprehensive Treatment for All Facets of Alcoholism Physician Directed * We stand alone in serving physicians, dentists and health care specialists. Family Treatment Included

• Specially trained experienced medical operators. Cost Effective Outpatient Program • We are a sincere group of professionals who care Covered by many Health about you and your practice. Insurance Plans

• Complete paging service since 1938. FOR INFORMATION CONTACT: Ted Berning, Administrator 5909 Orchard St. West Office: 272-4111 Tacoma, WA 98467 (206) 473-7474 Exchange: 272-3166

Locally owned and operated.

CROSSROADS 908 Broadway, Suite 201 TREATMENT Tacoma, WA 98402 CENTER An Approved Washington Alcohofism Treatment Facility

MSPC NEWSLETTER 4 MARCH, 1987 CONTINUING MEDICAL EDUCATION

C A T E G O R Y 1

FUNDAMENTALS OF INTERNAL MEDICINE

Tacoma Academy of Internal Medicine Annual Meeting Jackson Hall March 12, 13, 1987

Thursday, March 12 Friday, March 13

Pharmacotherapy In Cardiac Hepatitis B & D Arrythmlas Hepatic Encephalopathy Transluminal Angioplasty Acute Upper Gl Bleeding Thrombolysis In Myocardial Nonsteroidal Anti-inflammatory Infarction Agents and the Upper Gl Tract Fibrocytls: Recent Revelations Immunosuppressive Therapy in Sleep Disordered Breathing Cardiac and Renal Transplant Pts. What's New and Exciting In Antiviral Chemotherapy Pulmonary Disease Communicable Diseases Role of Steroids in Obstructive Pulmonary Disease

PREREGISTRATION REQUIRED For further information call: COLLEGE OF MEDICAL EDUCATION 627-7137

SURGERY UPDATE 1987

Tacoma Surgical Club Annual Meeting

University of Puget Sound Thompson Hall A pril 24, 25, 1987

DEMONSTRATIONS & DISSECTIONS PAPERS Friday, April 24, 1:00 to 4:30 pm Saturday, April 24, 9:00 am to 4:00 pm Saturday, April 25, 8:00 to 9:00 am

PREREGISTRATION NOT REQUIRED For further Information call: COLLEGE OF MEDICAL EDUCATION 627-7137

* * *

MSPC NEWSLETTER 5 MARCH, 198 7 "CRUMMY DOCUMENTATION" ’Knowledge, performance and judgement were major "Crummy Documentation" is factors for system the major reason physicians failures," he said. If find themselves having those receiving the problems -with PRO/W, said letters were willing and J.C. Peterson, III, M.D., able to change their Medical Director, PRO/W. behavior they wouldn’t go Peterson appeared before on to the inspector RARE COINS the Committee on Aging at general. MAKE MONEY its February 6 meeting. Peterson said the govern­ FOR OUR CLIENTS... ment wants a system of Peterson went on to say accountability to deter­ that PRO/W reviewed 120,000 mine how medicine is charts during its last spending its money. And During rhe posr 10 years rore corns contract period (two the vice is going to get have outpaced oil. gold, silver, years). Of those 120,000 tighter. diamonds, even real esrove, os o charts, 5,000 were pulled superior investment averaging over 20% annual oppreaorion by reviewers as possibly If you'd like more informorion involving inappropriate regarding building vour own, personol care. 2100 of the 5,000 rare com portfolio please give me a charts were reviewed by call physician advisors. Here at HPCl we guarantee wnot we sell, and, wherher you’re a new Presanctioned letters were in./esroror a seasoned professional w e sent to 25 of those offer reviewed, three of which ■ INSTANT LIQUIDITY . ,. Published were hospitals, twenty-two bids rhar give PCG5 cosh values physicians. Five qt any nme. ■ LIFETIME GUARANTY o f coin physicians went through the authenticity hearing process and were ■ GUARANTEED REPURCHASE recommended for penalty. WAMPAC agreem ents ■ COMMISSION FREE counseling and soles service ■ UPDATED sraremenrs of value ■ PEACE OF MIND .. . Virh guar­ anteed PCGS coin grading B A 15-day return privilege ifyou'reocoHecrororoninvestor. . HRCI 9 • won/5 ro wortt with you to build a p rofita ble p ortfo lio .

m H E R T Z B E R G Faster Agency Payments I t * Rare Coin Investments, Inc. #•••- r _ — — — — — — ~~ ** “ “ " Prodata is the leader in electronic claims submission: P/ease send me more m e com (nformonon? Nome MEDICARE Coming Soon: #•••«■ MEDICAID LABOR & INDUSTRIES Address • ••«** D.S.H.S. K.C.M.B. #•••- #••••* Phone For information on #•••- how to speed up r r V M n p n N i your agency I G 1 535 DOCK STREET. SUITE 204 reimbursement call: ^ T f #•••- TACOMA. WA 98402 (206) 627-2883 or 1-900-826-0039 (206) 682-4120, 2333 Western Avenue. Seattle • ••«** #••••' A BONDED. LICENSED PROFESSIONAL •••••••••••••••••••••••••••••••••I”*" • • • • • ••••••• ••••••••••••#•%••••••• •••**

MSPC NEWSLETTER 6 MARCH, 1987 PIERCE COUNTY CHAPTER uF MEDH AL ASSISTANTS, SURVEY

Dear Doctor Please take .just a couple of minutes to complete this survey for us. The Pierce Comity Chapter of Medical Assistants appreciates your time and consideration. 1) Are you familiar with the organization of Pierce County Medical Assistants? Y E S N O ___ 2) Do you know that the American Association of Medical Assistants certifies medical assistants in co-operation with the National Board of Medical Examiners? YES ___ NO ___ The PCCMA meets monthly and provides an opportunity for medical assistants to network and exchange ideas, as well as for continuing education thru speakers, displays and demonstrations. 1 ) Are you interested in learning more about PCCMA and how the organizat.ion can benefit your staff and ultimately you as an empJoyer and physician? Y E S N O ___ 2) Would you be interested in having a member or members of your office staff benefit from a membership in PCCMA? Y E S N O ___ Annual dues for the PCCMA are $65.00, and a monthly meeting dinner fee (optional) is $6.DO. 1) Would you help pay the dues for a member or members of your staff to belong and participate in PCCMA? One staff member ______Total dues ______Partial dues ____ More than one staff member ____ No dues ____ 2) Would you allow your medical assistant to leave at lunch for a couple of hours once a month to attend a meeting or educational program sponsored by PcCMA? Y7ES ___ N O P A I D ____ UNPAID ____ 3) Do you support continuing education and professional affilia­ tions for your employees? YES ___ N O PAID ____ UNPAID___ GENERAL COMMENTS ______

TRANK YOU. PLEASE RETURN TO: MEMBERSHIP BENEFITS, INC., 705 SO. 9TH, SUITE 301, TACOMA, 9840d . Watch the MSPC' Newsletter for further information regarding the benefits of PCCMA for vour employees or call Dixi at 383-332o, or print your name and phone number below and a representative will contact you with more information. KNOW YOUR LEGISLATOR?? 27th District Ruth Fisher...... 78b-7930 With the important Art Wang...... 786-7974 legislation to be considered 28th District COMPUTER USER (MXJP in 1987, it is imperative Sails' Walker...... 786-7890 TO MEET ON 4TH WEDNESDAY that you know your legislator Shirley Winsley..■.786-7958 and how to reach him/her. 29th District The first meeting of the P.J. Gallagher 786-7906 MSPC Computer User Group Listed below by Legislative Brian Ebersole 786-7996 nqnip together on January 14 District is the legislators 30th District and saw much interest in and telephone number. You Jean Marie Brough..786-7830 continuing the meetings. can write them at this Dick Schoon. .... 786-7898 address: A wide range of topics was tossed out for future Represenative______subjects for meetings. Senator ______Such as: Use of Modems, Legislative Building Software applications, Olympia, WA 98504 Vendor presentations, and many other topics of Legislative Hot Line is: interest. 1-800-562-6000 Martin Mendelson, mode­ FORMER WASHINGTON POST rated the session held at Call the Hot Line number to EDITOR ADDRESSES Tacoma General Hospital. leave a message with your RETIRED MEMBER LUNCHEON Plans are to have monthly legislator. meetings on the 4th Wednes­ Retired member luncheon day, 7:30 p.m., Tacoma Senators: held January 14 attracted General Hospital. over 60 retired members and 2nd District spouses. If you have an interest in R. Ted Bottiger ...786-7602 computers, plan to attend. 25th District Having served over 20 years You can be assured of Marcus Gaspard 786-7648 as City Editor for the leaving the session with 26th District Washington Post, the some valuable information Bill Smitherman....786-7650 speaker for the day and access to a lot of help 27th District Mr. Ben Gilbert kept the from your colleagues. Lorraine Wojahn....786-7652 group’s attention with 28th District stories of his attending Stan Johnson...... 786-7654 FDR’s press conferences and 29th District comparing them with todays A.L. Rasmussen.... 786-7656 television and instan­ CHRISTMAS SPIRIT 30th District taneous coverage of Peter von Reichbauer President Reagan’s press In the true spirit of 786-7658 conferences. Christmas, members of the Tacoma Area Medical Representatives: The luncheons have become a Managers conducted a food very popular get together drive and raised funds to 2nd District for the retired members. help several families in Ken Madsen...... 786-7912 You needn’t be retired to Pierce County over the Marilyn Rasmussen..786-7656 attend. holidays. These families 25th District included two elderly Dan Grimm...... 786-7968 Mr. Gilbert answered many couples, a family with George Walk...... 786-7948 questions regarding the three children, a grand­ 26th District media’s role in society and mother raising five Ron Meyers...... 786-7964 particularly relating to children, and an Asian Wes Pruitt...... 786-7802 todays events surrounding family that included 7 the Iran/Nicaragua scandal. children.

MSPC NEWSLETTER 7 MARCH, 1987 AUXILIARY NEWS Call Karen Diraant, 851-9494 to request space on the A great big THAMK YCU to waiting list or to add everyone who participated another person to your with all phases of the very table - they can now be successful MSPC booth at changed to seat 9 persons. the Tacoma Mall Health Fair in February. Sally Palm- It's not too late to sign Larsen, Chairman, grateful­ up for the Legislative Nissan 3Q0 ZX 2+2 ly reported that she had telephone tree! If you are "never had so many volun­ interested in knowing about - FANTASTIC teer ." It was wonderful to legislation which affects have so many participants the medical community and There’s no better way to describe the insuring its success! would like to be kept Nissan 300 ZX 2+ 2. Fuel-injected V-6 abreast of it, please call power, improved suspension and Ticket sales have gone very Sharon Lawson, 564-6605. aerodynamics and a luxurious interior well for the March 18 that’s big enough for four— the Fashion Event and Show 300 ZX 2+2. See it today! sponsored by the MSPC Auxiliary, the Tacoma Stars,

Topping Nissan -Volvo Personal Problems of Physicians Committee 925 Market For Impaired Phy'sicians (Downtown) Tacoma Your colleagues want to help. Medical Problems, Drugs. Alcohol, Retirement, Emotional Problems THE NA M E IS Committee Members IVISSAIM Patrick Donley, Chairman 272-2234 Robert A. O'Connell 627-2330 John R. McDonough 572-2424 William A. McPhee 474-0751 Ronald C. Johnson 841-4241 Jack P. Hewer 588-1759 Demis F. Waldron 272-5127 Mrs. Marie Griffith 588-9371

GRADUATING SENIORS!!

The Auxilliary would like to recognize all our graduates this year. If you have a son or daughter graduating from high school, vocational school, college, graduate school, etc., please take a moment to fill this out and return it to the Medical Society office or Marge Ritchie, 4803 95th Ave. W., Tacoma, 98467, by A p r i l 1'

Student’s Name_

Parent’s Name __

Graduating from

Degree or Diploma received

Future plans

MSPC NEWSLETTER 8 MARCH, 1987 MSPC PICTORIAL DIRECTORY

Arrangements have been made for a new Pictorial Directory to be published in August. All MSPC active and retired members who want to have their photograph in the book, must plan to have their picture taken at one of the following scheduled sessions:

HUMANA HOSPITAL Boardroom 7-10 A.M. MONDAY, MARCH 9

GENERAL MEMBERSHIP MTG. Fircrest Golf 6-8 P.M. TUESDAY, MARCH 10

TACOMA GENERAL HOSPITAL Conference #3 7-10 A.M. TUESDAY, MARCH 12

GOOD SAMARITAN HOSPITAL Glacier Room 7-10 A.M. TUESDAY, MARCH 17

PUGET SOUND HOSPITAL Boardroom 7-10 A.M. THURSDAY, MARCH 19

LAKEWOOD HOSPITAL Classroom 7-10 A.M. FRIDAY, MARCH 20

ST. JOSEPH’S HOSPITAL Physician’s 7-10 A.M. MONDAY, MARCH 23 Lounge

RETIRED MEMBER LUNCHEON Tacoma Dome 11:30--12:30 WEDNESDAY, APRIL 8 Hotel

Appointments are not necessary, please drop by at your convenience. A jacket and tie is preferred. If you have any questions, please call Sue at MBI, 572-3709. AMA HANDBOOK CM MENTAL LEGISLATIVE WSMA LEGISLATIVE RETARDATION AVAILABLE WORKSHOP IN OLYMPIA POSITION ON ISSUES The American Medical The following CAT (Com­ In February all members of Association has published a munity Action Team) WSMA received a copy of the newly updated handbook to leaders attended a 1987 Legislative Guide. help primary care legislative workshop physicians and other health sponsored by WSMA on The Guide outlines the professionals diagnose and January 24. Ralph position WSMA has adopted manage the problems of the Johnson, WSMA President on the key issues of 1987, mentally retarded. Elect; Richard Hawkins, such as; Initiative #92, Dave Hopkins, George Animal Research, Smoking, Written by doctors for Tanbara, Bill Marsh and Liability Reform, Motor­ doctors, the new guide Marlene Arthur. The cycle Helmet and other interprets clinical issues purpose of the meeting was issues of importance to surrounding mental retarda­ to improve our "grassroots organized medicine and tion, discussing current lobbying". community health. definitions and classifica­ tions, medical and psycho­ The gathering heard Please read it so you can logical assessment and case Governor Booth Gardner and discuss the issues with management. Speaker of the House, Joe your legislators. King ask for physician The book costs $16.50 per support of the Governor ’ s copy and is available by education package. The writing to AMA, Book and Governor promised to work Pamphlet Fulfillment, OP- for the Uncompensated Care 314, P.O. Box 10946, Bill. Chicago, 111., 60610-0946.

MSPC NEWSLETTER 9 MARCH, 1987 705 South Ninth Street • Suite 203 * Tacoma, Washington 98405 • Telephone (206) 572-3666 GENERAL MEMBERSHIP MEETING TUESDAY, MARCH 10, 1987 Speaker Jule Sugarman, Secretary Washington State Department of Social and Health Services

(Uncompensated Care, Medicaid Reimbursement, Nursing Home Care, Etc)

DATE: Tuesday, March 10, 1987 TIME; 6:00 p.m. No host cocktails 6:^5 p.m. Dinner 7:\5 p.m. Program PLACE: Fircrest Golf Club 6520 Regents Boulevard COST: Dinner $12.50 per person

Register now. Please complete the attached reservation form and return it, with a check for the appropriate amount made payable to the Medical Society of Fierce Couaty, in the enclosed pre-addressed envelope, or call the Medical Society office, 572-3667, to confirm your attendance. Reservations musi be made no later than Friday, March 6th.

REGISTRATION: Yes, I(we) have set aside the evening of March 10 to join my fellow Society members for the presentation by Mr. Sugarman. ______Please reserve______dinner(s) at $12,50 per person (tax and gratuity included.) Enclosed is my check for ______. ______I regret I am unable to attend the dinner portion of the meeting. I will attend the program only.

Dr.______RETURN TO MSPC BY NO LATER THAN FRIDAY, MARCH 6 MSPC NEWSLETTER 10 ' m A r CH, 1987 APPLICANTS FOR Are you treating a patient MEMBERSHIP Moo K. Lee, M.D., General with a head injury? Practice. Born in Seoul, Korea, 12/3/53; Korea University, 1975; inter­ nship, National Medical Good Samaritan offers a continuum Center of Korea, 3/82- of care and 5 treatment options 2/83; Washington State License, 1985. Dr. Lee is currently practicing at for head injury patients. 11002 Pacific Hwy- S.W., #C, Tacoma. 1 JL Inpatient acute rehabilitation TASK FORCE APPOINTED TO REVIEW PRQ/W SANCTION PROCESS 2 WSMA Board of Trustees has Outpatient acute rehabilitation established a special task force to study PRO/W and federal Medicare review regulations, including: 3 A residential program for persons evaluating the 25 with severe head injuries Washington cases which have proceeded to the presanc­ tion and sanction process; 4 A day treatment center for persons and, reviewing the composi­ with moderate head injuries who tion and function of the require transitional living services PRO/W Quality Assurance Council, clinical ap­ propriateness of the decisions and recommenda­ A community-based treatment center tions made by PRO/W for persons with mild head injuries physicians\ reviewers, and the due process protocol 5 used by PRO/W. If your patient can benefit from one or more of these programs or if you want additional information contact: MSPC members serving on the 841-5849 for acute patients Task Force are WSMA President-Elect Ralph 845-1750 for community-based programs Johnson and Joseph Nichols. * > Our apologies to Good GOOD SAMARITAN HOSPITAL Samaritan Hospital for JCAH REHABILITATION CENTER inadvertantly leaving their and 407-14th Avenue S.E. name off their advertise­ CARF P.O. Box 1247 ment in the February accredited Puyallup, Washington 98371-0192 Bulletin. Providing physical rehabilitation for residents o f the Pacific Northwest fo r over JO years.

MSPC NEWSLETTER 11 MARCH, 1987 Custom RX Compounding Featuring Internists N at Progesterone Suppositories, Troche Tacoma's Finest Homes 25, 50,100,200, 400 mg.

Psychiatrists Minoxidil Lotion Richard C. Pessemier wanted for 1 ,2 ,3 ,4 ,5 % Sales Associate 40 hour contract positions excellent salary, benefits Union Avenue Pharmacy J72-41Office 759-2699 HOME 2302 S. Union Ave. Health Specialists N.W., P.S. Tacoma Swanson-McGoldrick, Inc. 3602 47th St. Ct. N.W. Wa s h in g t o n bi 'i i d im ; s u n r jq.> 752-1705 TACOMA. WASHINGTON <(8-W2 Gig Harbor, WA 98335

PHYSICIANS Vour Army R ese rv e Personnel Counselor would like to talk to you about the following opportunities in the VS Army Medical Department:

PART-TIME INCOME CONTINUING MEDICAL EDUCATION RETIREMENT POTENTIAL ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOR BY THE US ARMY RESERVE

Major Paul H. Lawhon, MSC 206-967-5046

Many groups TALK about building a better America- The Army Reserve WORKS at It.

MEDICAL SOCIETY OF PIERCE COUNTY B U L K RATE 705 South 9th, Suite 203 l) S P O S T A G E Tacoma, ‘Washington 98405 PAID TA C O M A . WASH.

P E R M IT NO. 60S r. r r. +A publication of the Medical Society of Pierce County

V O L . 2 , N O . 3 705 South 9th, Suite 203 Tacoma, Washington 57 2 - 3 6 6 7

MSPC PICTORIAL DIRECTORY Appointments are not 1987 DIRECTORY CORRECTIONS necessary, please drop by Time is running out, and at your convenience. A ALGER, JOHN R . , M.D. this is just another jacket and tie is pre­ Eliminate Tacoma office reminder to be sure to get ferred. If you have any address; Federal Way your picture taken for the questions, please call Sue office phone should be MSPC Pictorial Directory to at MBI. 941-8900. be published in August. McAlexander, Robert A., M.D. Unfortunately, we are NEIGHBORHOOD CLINIC Change Lakewood office unable to use any of the DESCRIBED TO BOARD OF address to 5900 - 100th pictures from the last book TRUSTEES St. S.W. instead of 5720 - as the Medical Society 100th St. S.W. contracted with a Califor- Dr. Ron Johnson, Puyallup Please correct the listing * nia Company which, by Family Practice physician in your Pierce County contract, would not and volunteer Medical Physicians and Surgeons relinquish copies for the Director for the Neighbor­ Directory for Barbara Society. hood Clinic addressed the Guller, M.D... Dr Guller’s March 3 meeting of the business address should This year, the Medical MSPC Board of Trustees. read 17404 49th Ave. Ct. Society is administering Johnson and nurse Barbara E., Tacoma, 98446 all aspects of the Pic­ Goforth described the torial, the photographer is activities and services of local, and we will have the the Clinic. photos for your Medical WANT ON IHE REFERRAL LIST?? 1 Society file. The Board encourages and The Society office receives urges members to become approximately 400 calls a Please be sure to drop by involved in the Clinic. it one of the following month from people looking Please call 627-6353 to for a physician. You can locations: volunteer your services be on that list. You must for a very worthwhile agree to accept patients Monday, April 6, Tacoma cause. General Hosp., Conf. Room with Medicaid coupons. #2, 7-10 a.m. Join over 250 of your colleagues and participate Tuesday, April 7, St. in this excellent community Joseph Hosp., Physicians service. The public looks Lounge, 7-10 a.m. to the Medical Society to provide information and Wednesday, April 8, assistance in finding a Retired Members Luncheon, doctor. Won’t you help. Tacoma Deane Hotel, 11:30 a.m. WAMPAC MSPC NEWSLETTER 1 APRIL, 1987 POSITIONS AVAILABLE

Committed family practice physician needed by urban Native American community for challenging and fulfilling practice. Excellent medical community, ideal location with nearby mountains, beaches and cultural activities. Good benefits package. Send CV: Puyallup Tribal Health Authority, 2209 East 32nd St., Tacoma, WA 98404.

MORTON, WASHINGTON, Private practice opportunity available for part-time Board certified/eligible Orthopedic Surgeon in the beautiful, rural community of Morton, southwest Washington state. Financial potential histories available. Practice located in an excellent, new clinical facility situated adjacent to 20-bed Morton General Hospital, which is affiliated with Virginia Mason Medical Center in Seattle. Excellent outdoor recreational opportunities. Send C.V. to: Patty House, Health Resource Services Group, Virginia Mason Hospital, 925 Seneca P.O. Box 1930, Seattle, WA 98111 (206) 223-6351.

Immediate openings - full time and part time positions and Directorship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice. Flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1-800-554-4405, ask for Ginger.

FAMILY PRACTICE - Excellent opportunity with Seattle’s leading provider of Family Practice. Positions available throughout greater Seattle. Current license BC/BE in family practice. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Ave. Suite 225, Seattle, 98121, Debbie Phillips, (206) 728-6888,

EQUIPMENT

Surplus Medical Equipment. Large inventory of diagnostic, office and home care equipment. Prices extremely reasonable. Call Lynda (206) 453-8892.

Retiring?? Call us regarding surplus equipment. Call 453-8892.

PRACTICES AVAILABLE

Equipped Medical Office including x-ray, 3 examining rooms. Suitable for orthopedic surgeon or family practice. Plaza Medical Center. Contact Mrs. Ray Lyle, 582-2405 or Dr. Liewer, 588-1759.

M.D. Internal Medicine, BC/BE to take over established practice in S.W. King County. Call Administrator, 248-4550.

OFFICE SPACE

Professional offices for rent. Advantages: good parking, close to hospitals, minimal rents, lab and x-ray in building. Call Dr. Moosey, 383-1717 or 383- 1718.

Looking for Dr. to share office space in 3,000 square ft. medical clinic in Puyallup, 1-5 days per week. Call Dr. Charochak, 858-5555.

MSPC NEWSLETTER 2 APRIL, 1987 CALL FOR NOMINATIONS

WSMA has requested nominations for the following Council/Commit­ tees. If you have an interest in serving on any of the following areas, please call Doug Jackman at the Society office.

COUNCIL ON COMMUNITY HEALTH SERVICES Aids Task Force Child Health Ad Hoc Task Force Drinking/Driving Task Force Jail and Prison Health Care Ad Hoc Committee Maternal and Infant Health Care Committee Mental Health Ad Hoc Task Force Senior Health Committee

COUNCIL ON PROFESSIONAL SERVICES Grievance Committee Medical Disciplinary Process Task Force Medical Education Committee Medical Service Committee Personal Problems of Physicians Committee Professional Liability/Risk Management Comm.

COUNCIL ON GOVERNMENTAL AFFAIRS Congressional Liaison Committee Emergency Medical Services Standard Comm. Industrial Insurance & Rehabilitation Comm. Legislative (State) Committee Medicaid Advisory Committee Pharmaceutical Committee

OTHER Judicial Council Liability Reform Steering Committee Medicare Advisory Committee PACE Steering Committee

Pierce County needs greater representation on WSMA Committees and you are invited to volunteer to serve. Most of the committees meet only quarterly or semi-annually. If you need more informa­ tion, call the office before April 15.

"TOBACCO FREE" SPIHTinT, Congratulations to the Testimony urging the DISTRICT School Board and ad­ adoption of the policy was ministration for a coura­ provided by the Society. geous vote. Alan Tice and Gordon Klatt At its March 25 meeting the addressed the Board on the Tacoma School Board voted health effects of tobacco. to prohibit the use of The School Board was most tobacco on district appreciative of the property. support.

MSPC NEWSLETTER 3 APRIL, 1987 SPEAKING FOR THE SOCIETY Carl Plonsky ...... Lister Elementary School The Speakers Bureau is one of the best and most Richard Schoen ...... 15TH ANNUAL DAY OF successful ways physicians Northwest Kiwanis can get before the public PEDIATRICS and help get medicine’s Arthur Smith ..... message to the people. Parkinson Support Group RECENT ADVANCEMENTS IN The following members PEDIATRIC SURGERY volunteered to speak to Ronald Knight ..... the groups listed. We Pacific Northwest Bell Sponsored by Mary Bridge Children’s recognize that many Hospital members are requested to Richard Bowe ..... Jackson Hall Auditorium speak without being Gig Harbor Lions April 4, 1987 scheduled by the Society office. We would like to For registration informa­ recognize your efforts tion call: Alisa also. Please call us if DISCIPLINARY BOARD RULING Adams..594-1280 you would like to be mentioned. The Disciplinary Board issued a declaratory ruling Robert Scherz ..... on ophthalmology/optometry Bellarmine High School referrals on December 12, 1986 as follows: the Barbara Guller ...... practice of accepting Mt. Tahoma High School referrals from another practitioner with the Harry Lawson ..... intent of having the other Mt. Tahoma High School practitioner provide Crossroads Treatment Center follow-up care beyond James Dunn ...... his/her scope of practice Alcoholism Mt. Tahoma High School is forbidden. In making A Program Designed to Provide the ruling, the Board said Comprehensive Treatment for David Brown ...... it would consider discipli­ All Facets ot Alcoholism Hunt Junior High School nary action on individual Physician Directed cases brought before it. Garth McBride ..... Family Treatment Included Tacoma Lutheran Home Cost Effective Outpatient Program

Personal Problems of Physicians Committee Covered by many Health Insurance Plans For Impaired Physicians Your colleagues want to help. FOR INFORMATION Medical Problems. Drugs, CONTACT; Ted Berning, Administrator Alcohol. Retirement, Emotional Problems 5909 Orchard St. West Committee Members Tacoma, WA 98467 (206) 473-7474 Patrick Donley. Chairman 272-2234 Robert A. O'Connell 627-2330 John R. McDonough 572-2424 William A. McPhee 474-0751 Ronald C. Johnson 841-4241 CROSSROADS Jack P. Uewer 58&-175? TREATMENT Dennis F. Waldron 272-5127 CENTER Mrs. Marie Griffith 588-9371 An Approved Washington Alcoholism Treatment Facility

MSPC NEWSLETTER 4 APRIL, 1987 CONTINUING MEDICAL EDUCATION CATEGORY 1

SURGERY UPDATE 1987......

Tacoma Surgical Club Annual Meeting

University of Puget Sound Thompson Hall A p ril 24, 25, 1987

DEMONSTRATIONS & DISSECTIONS PAPERS Saturday, April 25, 9:00 am to 3:45 pm Friday, April 24, 1:00 to 4:30 pm Saturda^1_^£rll_25i_8^00_Jo_9^00__am

Gastric Stapling Procedure Multiple Organ Failure Percutaneous Lumbar Diskectomy Diagnosis of Myocardial Contusion Peripheral Nerves of Arm & Forearm Present Concepts of Replant Surgery Anterior Urethroveslcal Reattachment Improved Utilization of Rt. Atrial In the Male Catheters In Critically III Pt's. Abdominal Perineal Resection for Prostate Revisited Rectal Cancer Making It Hot For Cancer Digital Sympathectomy Digital Sympathectomy for Treatment of Hemorrhoids Raynaud’s Syndrome with Vertical Banded Gastroplasty Gangrene Posterior Approach to Adrenal Cranial Nerve Disfunction and Kidney Following Carotid Non-lnvaslve Vascular Testing Endarterectomy Cranial Nerve Disfunction Following Anterior Urethrovlslcal Reaitach- Carotid Endarterectomy ment In the Male (AUVR) PCA - Porus Coated Anatomic Cement- Interventional Radiology less Total Hip Arthroplasty The Angelchlk Prosthesis for The Anatomy of Aortic Outflow Reflux Esophagitis Extra Operative Monitoring of Restorative Proctocolectomy Recurrent Laryngeal Nerve Hypothermia Function

PREREGISTRATION NOT REQUIRED For further Information call: COLLEGE OF MEDICAL EDUCATION 627-7137

MSPC NEWSLETTER 5 APRIL, 1987 THE DOCTORS’ EXCHANGE ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY

REAL ESTATE *c 3901 SOUTH FIFE STREET. TACOMA. WA 98409 .Another First (206)475-1622 Our Leasing Department oilers you Why settle for just A Variety ol Locations a phone number? Starter or extended service sites With the new A full time leasing staff lo fill your needs Information Display Pager Call Our Leasing Department you can receive Today at 475-1622 patient name, nature of call AND telephone No. INSTANTLY'

Office: 272-4111 Exchange: 272-3166 p^DIAPER RASH^t Locally owned and operated. IS MOT A W AY OF LIFE 908 Broadway, Suite 201 You can recommend professional diaper service with confidence. Tacoma, WA 98402 • Laboratory Controlled. Each month a random sample of our diapers is subjected to exhaustive studies in a biochemical laboratory. • Utmost Convenience. Thanks to pick up 3nd delivery service, our product comes when you need it. • Economical. All this service, all this protection against diaper rash costs far less than paper diapers — only pennies more a day than home- washed diapers. !#••• CAUTION TO YOUR PATIENTS. It is illegal to • ••* dispose of human excrement m garbage. Faster Agency Payments • ••• Parents are tfoing this with paper/plastic • ••• diapers. "Disposable" is a misnomer. Prodata is the leader in electronic claims submission: MEDICARE Coming Soon: #••• i ” Draper MEDICAID LABOR & INDUSTRIES #••• •••• Service D.S.H.S. K.C.M.B. • ••* TACOMA WATOLL FREE 333-BABY 1-800-562-BABY For information on «••• how to speed up #••• Washington's Oldest, Most Trusted #••• Professional Diaper Service your agency Serving Our Second Generation reimbursement call: • ••* (206) 682-4120, 2333 Western Avenue, Seattle • ••* #••• _ • ••••••• I M M • » • • » • • • • • •*»

MSPC NEWSLETTER 6 APRIL, 1987 KNOW YOUR LEGISLATOR?? 27th District Ruth Fisher...... 786-7930 With the important Art Wang...... 786-7974 LEGISLATIVE ALERTS legislation to be considered 28th District in 1987, it is imperative Sally Walker...... 786-7890 Be watching for legislative that you know your legislator Shirley Winsley....786-7958 alerts from the Society and and how to reach him/her. 29th District WSMA as the Legislature P.J. Gallagher 786-7906 begins to finalize some of Listed below by Legislative Brian Ebersole 786-7996 the bills still alive and District is the legislators 30th District out of committee. sind telephone number. You Jean Marie Brough..786-7830 can write them at this Dick Schoon...... 786-7898 SB 5886 .. Certificate of address: Need Represenative______SB 5781 .. Mandated Senator ______Medicare Assignment Legislative Building HB 1102 .. Optometry drug Olympia, WA 98504 provisions Legislative Hot Line is: SB 6048 .. Tort Reform 1-800-562-6000 SURGICAL PAYMENT CUTS Provisions (Support) Call the Hot Line number to BEING CONSIDERED BY MEDICARE HB 161 .. Motorcycle leave a message with your Helmets for Children legislator. Congressional health SB 5401 .. Natural Death Senators: committees, searching for Act Amendments budget savings, considering 2nd District price curbs on many HB 477.. Basic Health R. Ted Bottiger ...786-7602 surgical procedures — such Plan 25th District as hip replacement, heart Marcus Gaspard 786-7648 bypass, and prostate surgery — that are most If you would like a copy of 26th District common among elderly any of these bills, call Bill Smitherman....786-7650 Medicare patients. the Legislative Hot Line 27th District #1-800-562-6000. Tell the Lorraine Wojahn...,786-7652 Such a fee schedule is operator the bill # and it 28th District still more than two years will be sent to you. Stan Johnson...... 786-7654 away. Meanwhile ardor for 29th District a White House budget office A.L. Rasmussen.... 786-7656 proposal to pay radio­ 30th District VISIT YOUR LEGISLATOR logists, anesthesiologists, Peter von Reichbauer 786-7658 and pathologists (RAPs) a Plan on visiting your leg­ fixed rate per diagnosis- islator during the present Representatives: related group (DRG) also session. Visit the Senate may be cooling as ad­ and House galleries and 2nd District ministration officials watch democracy in action. Ken Madsen...... 786-7912 struggle to work out the Walk through "Ulcer Gulch" Marilyn Rasmussen..786-7656 specifies of a proposal. and see the lobbyists in 25th District Moreover, even if adoped, action and see the marvel­ Dan Grimm...... 786-7968 the RAP DRG would produce ous rotunda. George Walk...... 786-7948 only marginal budget 26th District savings in 1988. Call the Society office Ron Meyers .786-7964 if you would like to Wes Pruitt...... 786-7802 For more information on schedule a visit. this subject please see AMNEWS (March 13.)

MSPC NEWSLETTER 7 APRIL, 1987 AUXILIARY NEWS

I'id you ever have the urge year, the co-operative 3 0 0 Z X tn pull on your Levi’s and fashion event held in the boots and tromp through a Tacoma Dome on March 18 in tulip field0 How about conjunction with t.he Tacoma tasting a few of the pretty Orthopedic Guilds, the colored flowers that are Junior League, and the suddenly sprouting every­ Tacoma Stars, was a great Nissan 300 ZX 2+2 where? The April 17 success. Although the auxiliary meeting is financial totals are not r - FANTASTIC certainly one you mustn’t yet available, "a good time raiss! was had by all" and those who gave so much of their There's no better way to describe the Marianne Binetti, garden time and energy are N issan 300 2 X 2 + 2. Fuel-injected V-6 power, improved suspension and columnist for the Puyallup certainly to be thanked. aerodynamics and a luxurious interior and Sumner newspapers, will It was quite an undertak­ that’s big enough for four — the be presenting a program at ing! 300 ZX 2+2. See it today! 10:00 on "Edible Flowers and Lazy Gardening" which will be held in the APPLICANT FOR MEMBERSHIP greenhouse of Roger and Kitty Knutson (Susie Brian J. Berry, M .D ., Pediatrics. B o m in Topping Nissan -Volvo Duffy’s sister). Lunch, Virginia, 10/03/55; 925 Market which will also be served University of Washington, (Downtown) Tacoma in the greenhouse, will 1982; internship, feature pansies in the Childrens Hospital of Los jello and a cake decorated Angeles, pediatrics, 7/82- with edible fresh violets THE NAME IS 6/83; residency, Childrens in addition to the "tastes Hospital of Los Angeles, NISSAN of tulips." pediatrics, 7/83-6/85; Washington State License, Following the lunch, there will be tours of the tulip 1987. Dr. Berry is currently practicing at fields and the flower 521 South K Street, packing facilities, so wear Tacoma. your jeans and boots and bring your cameras! Cut Custom RX Compounding flowers will be available Nat Progesterone Suppositories, Troche at wholesale prices and 25,50,100, 200,400 mg. other baskets will be PRESCRIPTION PADS STQT.PN! ! I Minoxidil Lotion available, too. Everyone 1.2,3,4,5% is welcome - including If you are unfortunate guests, so look for the map enough to have your Union Avenue Pharmacy in the "Pulse" and plain to prescription pads stolen, 2302 S. Union Ave. come and bring a couple of there is help just a phone Tacoma friends. Remember, April call away. The pharmacists 752-1705 17 at 10:00. Call Rubye of Pierce County have a Ward (272-2688), Alice Yeh well established phone tree (565-6929) or Mimi Jergens system in place. If you (1-851-5720) for reserva­ will call a registered tions. pharmacy, they will initiate the calls to The one fund-raiser of the inform their colleagues of the stolen pads.

MSPC NEWSLETTER 8 APRIL, 1987 MSPC T.RAPKRSHIP HEALTH DELIVERY SYSTEMS EMS COMMITTEE AND ATTENDS AMA CONFERENCE CLEARIM2KXJSE CREATED BOARD OF TRUSTEES MAKE STATEMENT TO George Will, nationally A central source of BOARD OF HEALTH syndicated columnist, information on health William Roper, M.D., delivery systems has been Administrator, HCFA, John created by the AMA. The EMS Committee under the Rother, AARP; Dennis chairmanship of Jim Fulcher O ’Leary, President, JCAH, In operation since Decem­ and the MSPC Board of Donald Rumsfeld, Presiden­ ber, 1986, the Clearin­ Trustees have prepared a tial aspirant and many ghouse was created to: statement to be presented other experts in their to a study session of the field addressed the — provide information to April 1 meeting of the February 19-22 AMA Leader­ enhance physicians’ Board of Health. ship Conference. Attending understanding of all from MSPC were Dick Bowe, aspects of current delivery Dr. Fulcher, representing President; Bill Jackson, systems, the Medical Society and President Elect and Doug — respond to specific representatives of the Jackman, Executive Direc­ inquiries by physicians ambulance companies, Pierce tor. regarding health delivery County Fire Chiefs and systems, hospital council will George Will quipped, "the — provide a means for the present their views on mutual exchange of informa­ American people have a prehospital care in the tion between the AMA, voracious appetite for county. government, a government physicians, and the federation. which will be governed by The Society is encouraging deficit." He also said, the Board of Health to "every five years Congress Clearinghouse staff are on- improve patient care by hand during regular corrects Social Security development of an EMS business hours to answer for the next 50 years." system that includes a any questions you may Will’s concept of leader­ central authority base have...about health ship is the "ability to with overall system delivery systems or about inflict pain and get away responsibility which would the Clearinghouse itself. with it." provide central medical Call 312-645-4729. The Society office has control, data retrieval and cassette tapes available analysis, and allocations The first product to be from presentations given at of resources. offered by the Clearin­ the AMA Conference. ghouse - the Physicians’ Resource Guide to Health Tapes are available on: Financing Health Care for Delivery Systems - is now the Elderly available.

Professional Self-Regula- Contents of this publica­ tion tion range from a history and overview of current Technology and Management systems, to a national of Change resource listing of organizations and agencies involved with HMO’s, PPO’s Public Affairs, Public and IPA’s, giving you a Policy and American Society comprehensive view of the (George F. Will) subject.

To order copies of the Guide, call toll-free 1- 800-621-8335. WAMPAC

MSPC NEWSLETTER 9 APRIL, 198 7 705 South Ninth Street • Suite 203 • Tacoma, Washington 98405 • Telephone (206) 572-3666

LUNCHEON MEETING FOR RETIRED MEMBERS (and SPOUSES) OF THE MEDICAL SOCIETY OF PIERCE COUNTY

with John R. Alger, M.D. "Experiences in Saudia Arabia"

DATE: Wednesday, April 8, 1987 TIME; Lunch 12:00 Noon Program 12:45 PLACE: Tacoma Dome Hotel (Hickman South) 2611 East E Street COST: Lunch 19.00 per person

Register now. Please complete the attached reservation form and return it, with a check for the appropriate amount made payable to the Medical Society of Pierce County, in the enclosed pre-addressed envelope, or call the Medical Society office, 572-3667, to confirm your attendance.

Reservations must be made no later than Friday, April 3rd. REGISTRATION: ______Please reserve______lunch (es) at 99.00 per person (tax and gratuity included.) Enclosed is my check f o r ______, ______I regret I am unable to attend the lunch portion of the meeting. I will attend the program only.

Dr.______RETURN TO MSPC BY NO LATER THAN FRIDAY, APRIL 8

MSPC NEWSLETTER 1 0 APPTT, Are you treating a patient DR, BOND DIES MARCH 12

with a head injury? Dr. Robert G. Bond, Family Practice Physician, a member of the Medical Good Samaritan offers a continuum Society for 40 years passed away March 12, of care and 5 treatment options 1987. for head injury patients. Dr. Bond, who had been suffering from ill health for some time began his Pierce County practice in 1947 after graduating from 1A Inpatient acute rehabilitation the University of Louis­ ville and spending two years residency with the Pierce County Hospital. 2 Outpatient acute rehabilitation Dr, Bond was born in Medicine Hat, Alberta, Canada on October 14, 1915. He was board 3 A residential program for persons certified and he was a with severe head injuries founding fellow of the American Academy of Family Physicians. 4 A day treatment center for persons with moderate head injuries who The Society extends its deepest sympathy to his require transitional living services family.

5 A community-based treatment center for persons with mild head injuries HCFA/FRO/W !! If your patient can benefit from one or more of these Who is calling the shots programs or if you want additional information contact: and setting policy..HCFA or 841-5849 for acute patients PRO/W? What is the relat­ 845-1750 for community-based programs ionship between the two organizations.

Plan on attending the May 12, General Membership Meeting at the Executive Inn. A top HCFA official will tell us why, how and GOOD SAMARITAN HOSPITAL what HCFAs plans are for j c a h REHABILITATION CENTER medicine. and CARF accredited

Providing physical rehabilitation fo r residents ofthe Pacific Northwest fo r over JO years.

MSPC NEWSLETTER 11 APRIL, 1987 FLOWERS

For your convenience fresh floral arrangements are available for delivery at Tacoma General and Mary Bridge. TGH Gift Shop, 594-1000.

STATE AARP WILL OPPOSE LIBRARY COMMITTEE The Committee will develop- INITIATIVE #92 CONSIDERING ing long range goals, in (Mandated Medicare STRUCTURE CHANGE light of the many elec­ Assignment) tronic advances now making The Library Committee under information available to The state chapter, American the guidance of Chairman, the individual that was Association of Retired Dr. Gil Johnston is only available in the Persons (AARP) has informed considering the feasibility library.. legislators it is opposed of becoming an incor­ to initiative #92. porated, non-profit organization. The WSMA is supporting AARP attempts to strengthen the Presently, the Library is a Natural Death Act (SB loosely structured consor­ 5401/HB 581) and lifeline tium of the Medical telephone service pro­ Society and members of the visions. Currently, Hospital Council. Initiative 92 remains in Financial support for the the House Health Committee library is derived by and the Senate Ways and contributions from the Means Committee. Council (60%) and the Medical Society (40%).

MEDICAL SOCIETY OF PIERCE COUNTY B U L K RATE 705 South 9th, Suite 203 VJ.S P O S T A C I Tacoma, Washington 98405 PAID MEDICAL SOCIETY OF PIERCE COUNTY If you’d like your older patients to be a little more comfortable, just prescribe this number 572-2323

T h a t’s th e n u m b e r fo r a new co n cep t • T h e C igm a Travel C lub. • Private rooms at the semi-private race in caring about older Americans, It's called • Assistance in preparing Medicare or other (when available). Hum ana Seniors Association, and it’s a locally insurance forms. • Krec overnight stay in the patient’s room directed, non-profit organization aimed at mak­ • Transportation to doctors' offices or hospital. by a sp o u se o r fam ily m em ber. ing life just a little easier for Tacoma’s senior • Subscription to a special newsletter edited • Special registration by telephone. citizens. Membership in Humana Seniors fo r seniors. • Expedited courtesy check-out procedures. A ssociation costs just p en n ies a clay. Vet ii p ro ­ • In-patient and home visitations, where • One m onth's free use of the Personal vides a whole range ol services aimed at mak­ required or requested. Security' Communications Device, after ing life more pleasant and secure lor members. Members art also eligible for discount d ischarge. M embership allows access to: mail-order drugs and a reduced monthly W h e n y o u c h e c k y o u r o ld e r patients • A special seniors advisor to provide counsel­ lease fora Personal Security Communications into H um ana’s special Geriatrics Unit, you ing and information as well as a link io com­ Device —a system thal provides a remote con­ know they’re being admitted to one of the munity organizations and as ,i resource for trol phone link for emergency use. Pacific Northwest's leaders in the field. ca re givers. If your patient requires hospitalization... Now we’re beefing up that leadership with • l-ree blood pressure checks. 1 lumana Hospital-Tacoma provides the Hum ana Seniors Association. We invite you • U el I ness and health education programs. I1 ’||< >wing services and am enities lor members: — and your patients—to become part of it. taimana Hospital-Tacoma I -nnyin'j !!„■ in iim.ii l.r-jH- in nr, <1 mi.j ijit. hands ol'j doitor.'

i Sin.-.-is Tadim a, IV A 9840S The Bulletin

The official publication of the Medical Society of Pierce County

4 President's Page MSPC Officers: Richard G. Bowe, President; William B. Jackson, President-elect; Kenton C. Be All That You Can Be Bodily, Vice President; Robert B. Whitney, Secretary-Treasurer; Richard Hawkins. Past President. 5 Newsbriefs Dr. Tanbara honored MSPC Trustees: Michael L. Halstead, Peter K. Washington population speaks out on health care issues Marsh, Paul D. Schneider, Johann H. Duenhoelter 1987; Gerald W. Anderson, Ronald W. Knight, Eileen R. Toth. 1988, Susie Duffy. 7 Canine Rabies Case: Executive Director: Douglas R. Jackman From Tacoma-Pierce County Health Department

Board and Committee Chairman: A Case Study Bylaws Stanley Tuell; Budget/Finance: Robert B. Whitney; College o f Medical Education, PeterK. Marsh; Credentials: Richard E. 8 Can You Afford to Practice Waltman; Emergency Medical Standards: Medicine in 1987? James K. Fulcher Ethics/Standards of Practice: Ronald G. Taylor; Grievance: By Carlos E. Garcia, MD Richard Hawkins; Interprofessional: RobertJ. Martin; Legislative: Gregory A. Popich; Library: Gilbert G. Johnston; Medical 10 Impaired Physician Education: David Brown; Medical-Legal: A thought provoking article by the widow ol an "impaired physician" Marcel Malden; Membership Benefits, Inc., Donald W. Shrewsbury; Personal Problems of Physicians, Pat Donley; Program: Kenton C 12 Steps on Terminating an Employee Bodily; Public Health/School Health, Terry Reprinted from the Palmer Practice Management Report Torgenrud; UHI Quality Assurance: David Sparling; Committee on Aging: David R. Munoz. 13 Medical Records The Bulletin is published quarterly, February, Accepted policy on the transfer of medical records. May, August and November, by Ihe Medical Society of Pierce County, 705 South 9th, Suite 14 Physicians Step Forward 203, Tacoma, WA 98405. Telephone (206) 572 3666. Bulk Rate U.S. Postage paid at Tacoma, At Issue: Medical Care for Those Who Cannot Pay Washington. The Bulletin is published in the By Mary K. Tipton interest of medicine and allied professions. The opinions herein are those of the individual contributors and do not necessarily reflect the 16 Looking Back official position of the Medical Society. Acceptance of advertising in no way The Royal Scribe, By Mavis Kallsen constitutes professional approval or endorsement of products or services advertised. The Bulletin and the Medical 20 The Fable of Aesculapius and the DraGons Society of Pierce County resen/e the right to Once upon a time.... reject any advertising. Reprinted from EAR, NOSE and THROAT journal. By Bruce W. Editor: David S. Hopkins Jafek, MD

Managing Editor; Douglas R. Jackman 21 Auxiliary News Editorial Committee: David S. Hopkins (Chairman), Stanley W. Tuell, W. Ben Nominating Committee Report Blackett, Richard Hawkins Potluck, May 15

Production: Mary K. Tipton 22 Membership Advertising: Sue Asher, Membership Benefits, Inc., Medical Society of Pierce County 572-3709. Beverly Foley, 2607 Bridgeport Way West, 23 General Membership Meeting Registration Form Suite 2C, Tacoma, (206) 564-3839 Speaker Larry Camp from the Health Care Finance Administration

1987 February The Bulletin 3 President's Page That You Can Be!

How many o1 us have heard enough. When the "art of patients. that challenge on television given medicine" is lacking, two common External marketing is to the 18 year olds of America by complications arise, malpractice advertising. Most of us are happy the U.S. Army? And how many claims and grievances. Insurance to talk to our local service club, have given themselves the same companies constantly exhort us to senior citizens' group or at a challenge? How often do we stand talk to our patients openly about hospital forum. We are presenting back and look at ourselves critically unusual situations and minor ourselves to groups outside of our as to how we live our lives and how complications before they become own practices but in an informative we practice medicine as lawsuits. Having served on the and educational way. Incontrast, individuals, in our practices, and in Society's grievance committee for are radio, T.V. and newspaper ads our medical community? two years, I have strong feelings really necessary? Is the image we that most grievances stem from a convey good for medicine, As Individuals simple lack of communication -- the showing the best we can be? Most of us began medical very basis of the art of medicine. school with altruistic goals and high In Our Medical Community ideals of bringing health and caring In Our Practices Finally, we are established and to the people of the world. Quickly In addition to mastering the art take our place in the medical we learned the "science" of and science of medicine we also community. Not all of us feel medicine as well as we could - to soon realized that we had to have a compelled to get involved in pass exams primarily. We had to full schedule of patients every day specialty societies, hospital staff demonstrate a certain level of to earn the rewards that all our organizations or medical society competence to complete med training promised us. Doing a affairs, but there is a great need for school, internship, residency or consistently good job of treating dedicated people in each arena. I fellowship. Our idealistic thoughts patients used to be all that was look back at several individuals who were tempered with the necessary to satisfy the patients urged me to get involved several requirements of mastering facts. and referring doctors. This is still years ago and, although I may have Those facts were exciting and the most important element of cussed them at the time, now I brought a certain feeling of power success but recently a Madison thank them heartily for their as knowledge of any Kind tends to Avenue term has infiltrated the encouragement. In that same way, do. We realized that some were sanctity of medicine-Marketing. I I would like to urge those of you better at assimilating tacts than view marketing as two components who may be considering it, to others and these were the "top - Internal, the things you do within volunteer or let yourselves be students." We also realized that your practice to make it more drafted to positions of leadership in many times the 'lop students" desirable than the one down the the medical community. were noi always our idea of the block and External, advertising I think the Army has done doctors we wanted to be. pure and simple. more than coin a catchy recruiting As we began our contact with Internal marketing is a lot of slogan. I also think that "being all patients, usually in our second year little things that together make you can be" illustrates more than of med school, and increased that people like to come to your office. the Peter Principle. I think it gives contact through training and It's the smile on your receptionist's us a chance to reflect on our ultimately into practice, we realized face, the pleasant voice on the abilities in the art and science of a need to develop the "ad" of phone, helping patients fill out medicine, our practices as they are medicine -- that intangible element insurance forms, accepting viewed by both patients and our of rapport and caring that was often Medicare assignment when colleagues, and our involvement in all the doctors of old had to offer. indicaied, sending our informative the activities of our medical It is just as important now as it was newsletters to patients, asking Mrs. community. □ then in giving our patients Jones how her family is and many confidence in us and comfort when other nice touches that we pure science alone just isn't appreciate when we too become — Richard G. Bowe

4 The Bulletin May 1987 Community on an ability-to-pay basis. communicate, they would want to Health Care The Clinics are dependent on be able to tell their doctor to generous city, county and public withhold life support. Delivery support, including many who • 91 percent felt that a living volunteer services and donate will should protect their right to System supplies. refuse medical treatment. honors • 98 percent thought that doctors and other health Dr.George professional should provide Tanbara. Washington patients with enough information The Community Health Care population so they could understand their Delivery System (CHCDS) honored medical conditions. Dr. George Tanbara during open speaks out on • 78 percent said that house ceremonies March 26. economic sanctions such as tax on Dr. Tanbara was the guiding health care. alcohol should be used to force in getting CHCDS (formerly A series of community discourage unhealthy lifestyles. UHI Community Clinics) meetings were recently held • 79 percent believed that established in Pierce County in throughout the state in an effort to priority in funding should be given 1972. The five clinics are partially give legislators and health care to preventive healthcare programs funded through Federal grants to decision makers a community point over high tech programs that service the health care needs of of view on health care issues. prolong life. those unable to pay full fee. What follows is a summary of •50 percent support the belief In making the presentation, responses from 3,143 Washington that economic status or income should not be a criterion for Pierce County Council Chairman citizens who participated in determining who gets expensive Wendell Brown thanked Dr. Washington Health Choices. life-saving treatment. Tanbara for 15 years of continuous Of those who participated, 64 These opinions taken service. Dr.Tanbaraorganizedthe percent were from western collectively provide a community East Side Clinic in 1972. He is a Washington, 36 percent from perspective on some of the tough charter member and past president eastern Washington; 65 percent health care decisions facing of Tacoma Ambulatory Care Center were female; 88 percent had society today. (Family Clinic). health insurance; 43 percent had a Dr. Tanbara has consistently household income of $25,000 or provided volunteer pediatric more and 30 percent were over the specialty care for clinic and age of 65. community children both on-site at • 91 percent felt basic health Address Change East Side Clinic and his private care was the right of each office and at area hospitals. individual. Dr. Robert W. Osborne has moved He and his associates • 65 percent stated they his Tacoma office. Please note the established new born and on-call would agree to pay more taxes if correction in your 1987 Directory: backup services tor CHCDS government would finance health 1212South11th,Suite #42 midwives and Midwife Associates, care of the uninsured. Tacoma, Wa 98405 which allowed the obstetrics • 84 percent felt that the right His office phone remains: 383- program to be sustained. of patients to refuse medical 3325. In 1986, while underthe treatment should take precedence Pierce County Health Department, over other factors. Newsbriefs the Clinics cared for over 30,000 • 84 percent agreed that if a continued on next page. patient visits. Patients reimburse member of their family were terminally ill and unable to

1987 May The Bulletin 5 V Newsbriefs continued — Crossroads Treatment Center Physician Alcoholism • To foster and promote the A Program Designed to Provide Volunteers human rights of all people having Comprehensive Treatment for Needed. spina bifida and hydrocephalus. All Facets of Alcoholism • To promote public Physician Directed St. Leo's Neighborhood Clinic awareness through the national needs our help. The Clinic, and local spina bifida chapters. Family Treatment Included located at 1323 South Yakima, • To provide information and provides health care to the Cost Effective Outpatient emotional support to all who are Program homeless, needy and anyone who affected by spina bifida. walks in the door. • To offer financial assistance Covered by many Health The Clinic is open Monday and in the form of a urinary and brace Insurance Plans Thursday evenings from 6:00 p.m. fund. to8:00p.m. Doors close at 8:00 • To promote research into FOR INFORMATION p.m. It enough physicians could the causes, treatment and CONTACT: volunteer, one physician would not prevention of spina bifida and Ted Berning, Administrator be called upon more than once hydrocephalus. 5909 Orchard St. West every tour or five months to serve. Tacoma, WA 98467 The Clinic provides a badly needed (206) 473-7474 service in the community and otters all physicians, regardless of specialty an opportunity to participate. If you would like to take part in MSPC CROSSROADS a fine public service or have any Caribbean TREATMENT questions, please call the Medical CENTER Society office at 572-3667 or call Cruise An Approved Washington Alcoholism the Clinic nurse, Trudy at 627- Plan on it. A January, 17- Treatment Facility 4741. An article on the Clinic 24,1988, Caribbean Cruise with follows on page 14 and 15. your colleagues. Basic Cost will be approximately $2,700 per couple on Royal Caribbean "Song of ^DIAPER RASH^ Norway,” visiting five different IS NOT A W AY OF LIFE Spina Bifida ports. An orientation meeting is Y o u can recomm end professional scheduled for 7:00 p.m., diaper service with confidence. Chapter Thursday, May 14 at the Sherwood Inn, 8402 S. Hosmer. * Laboratory Controlled. Each month formed. a random sample of our diapers is subjected to exhaustive studies in a The Spina Bifida Association biochemical laboratory. of Puget Sound is a non-profrt organization built by the efforts of * U tm ost Convenience. Thanks to pick volunteers to help persons with up and delivery service, our product spina bifida achieve their maximum comes when you need it potential. Parents of children with MARKETAREA * Fconomical. AH this service, all this spina bifida and adults with this PROFILE protection against diaper rash costs condition offer support and far less than paper diapers - only The American Medical pennies more a day than home- information on community washed diapers. resources to others who are faced Association's Market Area Profile (MAP) Service can be of assistance with the challenges of this CAUTION TO YOUR PATIENTS. It is illegal to dispose ol human excrement in garbage. problem. Interested parties can to physicians initiating and/or expanding their practices. MAP Parents are doing this with paper/plastic get in touch with the Spina Bifida diapers "Disposable" is a misnomer. Association volunteers in Pierce offers data on population, five-year and King Counties by calling Gail demographic projections, hospitals, and physician Baby Belflower of Tacoma at 581 -3070 Diaper or Barbara Goeckel of Seattle at information-number, ages and specialties-in specific areas. For Service 362-0563. The Spina Bifida Association information, contact MAP Service, TACOMA WA TOLL FREE c/o AMA 535 N. Dearborn St., 383-BABY 1 -800-562-BABY of Puget Sound's goals are: Washington’s Oldest, Most Trusted Professional Diaper Service Serving Our Second Generation 6 The Bulletin May 1987 4S i F treatment regimen for individuals Tacoma-Pierce County Health Department... with inadequate immunization history.) Suspect: Canine Rabies Case History of Rabies in County, State, Country, World: Unique Features of This The last positive dog case in The following article is a case Pierce County occured in 1942. history of a suspect canine rabies Recent Canine Case Are: Rabies used to occur in dogs, farm case by Dr. Noreen Harris. For 1. It was detected animals, cats and people in Pierce further information contact Dr. 2. The prolonged incubation Harris at591-6468. period County. Bats were first tested in The Editor 3. The short illness the 1960's - - from that time forward, roughly 10% have been 4. This may prove to be only the second confirmation ( using positive each year. The last positive dog and cat Background on Case: monoclonal antibodies) of a bat-to- case in Washington State occured This past June a family from the dog transmission in the United in Thurston County 1976 Lakewood area called the Tacoma - States. and1977. The sources of those Pierce County Health Department 5. The post-exposure vaccination infections were most likely bats. seeking advice about two low- of this dog did not prevent We have had four skunk cases in flying bats hovering in their disease. Washington State which were backyard near their dogs' kennel either imported or vaccine- with their two German Sheperds Animal Vaccination induced. Rats and squirrels are not (aged 6 months and 11/2 years). As a matter of routine, we are known to transmit rabies to The older dog had received one advising all veterinarians to strongly humans, and are among the injection of rabies vaccine at six recommend rabies vaccinations for mammalian species least likelyto months ofage;thepuppywas dogs and cats, as 10% of the bats be rabid. Wild animals most likelyto unvaccinated. The Department tested annually for rabies in be rabid in the United States are: encouraged the family to have the Washington State are positive, and skunk, raccoon, bat, fox ( in order bats tested by the Seattle-King each year several people in County Health Department. The Washington State are exposed to of decreasing frequency) .□ bats proved to be rabid on Rabies rabid bats and require treatment. Flourescent Antibody test, a sensitive and specif itc test when Rabies Pre-exposure Interested in writing? conducted by an experienced vaccine for Individuals virologist. We than quarantined the Exposed to bats, Carnivores The Bulletin welcomes the two dogs in their own kennel, on and Potenially Contaminated opportunity to publish articles from the owner's premises, for six Tissues As Part of Their the medical community, including editorial commentary and" Letters months, and the owners were Work: to the Editor." Articles submitted instructed to have the animals Also as a matter of routine, we forconsideration should be from vaccinated prior to the five months are encouraging veterinarians, zoo two to six, single spaced, into the quarantine. Only the pup workers, animal handlers and typewritten pages. For information received a vaccination which was technicians and pathologists to contact Doug Jackman at the given priorto quarantine. At the receive the new Human Diploid Medical Society office, 572-3667. end of the quarantine (Christmas Cell Vaccine intradermally ( about Day, 1986) the dogs were released $25 per injection, 3 injections) from the kennel. Ten days later, which provides lifetime protection the puppy (now one year old) died against inapparent exposure. This The animal was symptomatic for vaccine is painless and safe, unlike only 30 minutes with vomiting, the oldervaccines. Reach the Medical Community tremors, excess salivation and Anyone who has demonstrated Advertise in convulsions. The methodology an adequate titer at any time in the used to confirm this case is very past need not be re-vaccinated. The Bulletin accurate. ( Four smears were However, when an exposure to a positive using commercial rabid animal occurs in a previously For information and rates call: conjugate, and one using the immunized person, two boosters Beverly Foley, 564-3839 Centerfor Disease Control’s of Human Diploid Cell Vaccine are conjugate.) Nevertheless, all advised, as compared to a full or Sue Asher, Membership materials have been sent to the course of the 5 HDCV injections, Benefits, Inc., 572-3709 Centers for Disease Control for combined with Rabies Immune confirmation. Globulin. (The latter is the current

May 1987 The Bulletin 7 Impact on Claims... Can You Afford To Practice Medicine in 1987? By Carlos E. Garcia, MD

Introduction While the trend towards the "tail insurance” has not previously Within an established "Claims Made" policy of Medical been considered in partnership association planning for the "worst Malpractice insurance is well contracts. Employers or senior case scenario” may produce established, practical experience partners will feel the need to insure tremendous strain. This seems with this insurance form is minimal. against the penalty of tail insurance unavoidable when a possible This lack of experience is now for a prospective partner who breakup results in an obligation of critical since the cost of purchasing leaves their practice saddling them nearly $140,000 for each partner the "tail" forthese policies is so with that cost. Conversely, if the leaving practice. Conflicts are large. This cost will have an impact contract for employment assigns a created when dealing with a on career decisions that high portion of the tail insurance to the partnerconsidering relocation or premiums by themselves did not. prospective partner the cost of with a senior partner nearing The practitioners most vulnerable joining and then leaving a group retirement age and about to incura to these new costs are those may be prohibitive. large penalty. beginning practice or nearing retirement. Doctors contemplating a change in practice location, joining or leaving a partnership, considering additional training or early retirement will also be affected. W o r k i n g Beginning or S o l u t i o n s expanding practice A doctor starting practice Professional Services underthe new "Claims Made" insurance assumes a penalty for For The Injured failure which will severely limit 410 S.W. I53rd St. Seattle, W A 98166 practice options. The penalty is (206) 244-5460 >Serwigjalj_Pietgg_and King Counties-near SeaTac Airport the cost of "tail insurance." This represents a sharp increase in the obligations usually associated with Chronic Pain the initiation of practice. This cost is incurred when the practice begins and is payable soon after a M a n a g e m e n t venture fails. The magnitude of Intensive 3-Week Program this cost is enormous. A class Return-To-Work Emphasis seven specialist leaving a practice at the end of one year can be assessed a payment of up to $70,000. The penalty for Physical Capacity Evaluations guessing incorrectly about the workability of a practice is now higher than ever. Ronald S. Winkle, M.D., Director Joining an established practice is no easier. The cost of

8 The Bulletin May 1987 Retirement insurance is not possible with all Conclusion When a physician can retire companies and when available this The opportunities for starting, without incurring a penalty may also trigger a payment at the joining or expanding a medical depends on the specific insurance time of change. practice are now limited by the carrier, but simply stopping a Retraining into a lower risk need to plan forthe possibility of practice temporarily or permanently specialty or taking time for a paying out the cost of tail is no longer possible. The cost of sabbatical is likewise limited. Two insurance. The economic impact is retirement will have its greatest companies expect full payment of potentially devastating since this effect on those wishing to retire premiums while on extended study cost is easily underestimated and before age 65 and those nearing leave. The prospect of paying a unfortunately falls due at the same retirement age without a minimum $60,000 to $70,000 premium time a practice stops. number of years under the new while generating no income from Understanding the new insurance form. (Of the 580 active clinical activities makes additional limitations on medical practice and members of the Pierce County training virtually impossible. When the features of plans from the Medical Society, 116 are 55 years time off for bona f ide medical study competing insurance companies is of age or older.) These is allowed partial premiums may be essential for career planning and practitioners are faced with the required. matching insurance coverage to problem of either budgeting for a practice goals. lump sum payment for tail insurance at retirement or 1.2 1.2 3 continuing work past 65 to Company Premium Cost of No Sabbatical Part Area accumulate the needed minimum 1st year 1st year Tail Time Covered years of coverage. There may be a 5th year 5th year tragic race to accumulate the large sum needed to retire in the few CNA $12,596 $51,210 10Yrs 25% of 50% of National & 65 yo Premium Premium years left to a physician nearing $47,860 $86,148 age 65. WSPIE $14,116 $36,324 5 yrs No cost 50% of WA State &65yo Premium Practice relocation 10 yrs & The geographical area leave Prac. in WA covered by the various insurance Doctors $11,300 $20,340 7 yrs No cost 50% of 6 states companies must also be 55 yo Premium considered if future options are to $25,280 $45,504 be protected. (Table) With the St. Paul $7,936 $32,121 5 yrs 100% of 100% of National most popular Washington state 6 65 yo Premium Premium $35,870 $59,427 plan, relocating outside the state ICA $11,620 $36,795 5 yrs 100% of 100% of National and staying with this company 6 62 yo Premium Premium simply isn't possible. This means that any job outside of Washington Notes: 1. Figures quoted are for Cardiovascular Surgery included in the highest state would have to be lucrative risk group by all carriers. enough to justify paying off the tail 2. Figures reflect $1,000,000/$3,000,000 limits while many specialties will be insurance penalty at the time of purchasing the higher cost coverage or $5,000,000/$5,000,000. departure. Even with insurance 3. AH companies excuse the cost of tail insurance for death or companies active in other states permanent disability. the transferability of coverage without penalty to those states is Disclaimer: These facts are system, policies and theirterms are not guaranteed. the result of my personal research in effect forthe current policy and should not be used as the sole period only. The features of your Career changes basis for decisions about malprac­ policy can be changed from year to The strategy of limiting tice coverage. If you can stand any year and you will have to check practice and avoiding high risk more good news: Under the claims them at each renewal to be sure of procedures to drop into a lower risk made what is being agreed upon. □ category with a lower "tail" cost seems obvious. Unfortunately, there may be a requirement for payment of a tail for the higher risk level at the time the character of practice changed. Pursuing a part time practice to drop the cost of tail "From the Diary of an Impaired Physician..."

C om piled by his w idow

Why 1 began drinking alone Gave me time to relax at home and at odd times of the day and without the usual stress. Itwas night I don't remember, but I do good to have a few quiet drinks in them. Or maybe it was when the know I felt tired a lot of the time and front of the TV and loosen the wife and daughter spent the a quick drink helped me relax, knots. summer in Europe and I slept in the helped relieve the tension I But everything in our lives office sometimes instead of making seemed to carry with me, and took money, and the way I earned the long drive home. It must have seemed to make everything flow a money was to practice medicine. been then, because when they little smoother. I loved my medical And I was good at it. My colleagues got back I told them I wanted to practice, respected my patients, praised me lavishly for making move to the City and quit the long and gave the art of medicine my accurate and impossible commute. It was too stressful, all best talents and most of my time. I diagnoses. The hospital touted my the traffic and wasted time behind tried to make my wife and kids new technique developments and the wheel. By the time I had a understand why I couldn't always praised the time I gave to patient couple of drinks and relaxed I make all the events that were care. I came early and left late. I sometimes didn't even feel like important in their lives, especially carried work home and explained doing the work I brought home. my son’s swimming meets, my to the family that doctors didn't I thought moving to the City daughter's Girl Scout events, and work set hou rs like other people would make it easierto have more several of my wife's parties, for I did. But my stomach churned a lot social life but it didn’t work out that was a good doctor and the welfare of the time, and I told myself that it way. It surprised me the way my of my patients came first. But I took wouldn’t look good if a doctor friends had changed. Oh, they still good care of my family. Whenwe developed ulcers. Usually, a referred patients, told me itwas felt the public school had become couple of drinks would quiet the amazing how I never missed a a shambles I was pleased we could tumult and get me on an even keel. diagnosis, but they quit dropping afford to send the kids to a good The night calls were getting harder, around after office hours for a private school. When everyone too. The body resisted the quick friendly drink - like we used to do - was learning to ski we afforded a get-ups and fast take-offs more and I felt left out. We didn't seem place in Tahoe, and when than it used to, and I found that a to get invited out much either, but community activities and social life quick shot before I left home then my wife never did like having demanded pretty clothes and warmed the limbs and shortened people at our house on a social expensive charity affairs I was the night. I knew drinking too basis. But, then, medicine was proud my wife could be involved. I much was ridiculous - a real tax on changing so much it was no took good care of my family. Yet the liver and the rest of the body. I wonder friends were changing too. my wile complained about our lack knew the dangers of over­ The only thing that made the of time together. She said we prescribing for my patients and 1 morning mail palatable any more never had time to talk, and our sex certainly wasn’t going to do it to was a little vodka in the coffee, life was infrequent and often myself. every day brought new personal disastrous. The kids became smart When I began keeping a bottle premium increases or another alecks; sometimes \ felt like in my drawer at the office I don't encounter with an insurance smacking them they were so sassy remember. It was sometime company over a patient payment or and disrespectful, but my wife around the time my son got news of another malpractice suit. always ended up handling the expelled from school for smoking But the greatest disappointment of situations, and I never stopped pot in the locker room. I never all came when hospital elections loving them. It did come as sort of a understood about that. It only he rolled around. I had always thought relief, however, when they began had come to me I could have told I would be chief of staff one day, making their own weekend plans him about the hazards of drugs and and I had let it be known that I was and took vacations without me. the folly of getting involved with now available. But no one 10 The Bulletin May 1987 nominated me. When I asked Jim the best in the business. She in the hell should I know? My about it he intimated that it might didn't bother me about anything. advice is to quit drinking and get be betterto wait a couple of years, They deserved a raise at the end of back to business." It does seem and it wouldn't hurt if I cooled it a the year. I hoped the practice strange to me, though. I've spent little on my drinking. What in the would pick up so I could give it to all my life working in hospitals and hell did he mean? He drinks too, them. with doctors and no one seems to and I've never heard of anyone at I should have been surprised, know how to help me. Where do I the hospital complain about but somehow I wasn't. My wife go now? □ drinking booze at the staff moved out and told me she was meetings or at the office parties. I'd filing for divorce. Moved out my From: San Francisco Medicine, about had it with the whole bunch. bank account, my retirement plan, Jan., 1987. If it weren't the best hospital in most of the furniture and all her town I'd apply for staff privileges belongings. Saidshecouldn'ttake somewhere else. it anymore. Said she needed to I decided it was time to cool it build a new life for herself. Said for a while, as Jim suggested. My she wasnl ready for her life to be For impaired physicians. office nurse found one of my over yet. Strange! Seems I can't Your colleagues want to help. bottles in the back of the toilet. I count on anybody anymore. Not Call Dr. Patrick Donley, MSPC forgot I had put one there. Told my wife, not my friends, not even Chairman of Personal Problems myself I had to cut that out but I my patients. of Physician Committee at 272- acted surprised about the whole Today I decided I'm going to 2234, for help with personal thing, they knew what stress I have to do something about my problems, drugs and alcohol, worked under, and they helped me life. I think I have a drinking retirement, medical or other get through each day. They problem. I had another blackout emotional problems. spaced my appointments so I could yesterday and it scared me. I talked grab a couple of naps now and to Jim and asked him if he thought I then, and my office manager was was an alcoholic, and he said, "How

1987 May The Bulletin 11 S teps to Terminating an Employee: How Can There Be a Graceful Exit?

No one likes to be the suggestions on how performance to resign. If so, ask for a "heavy," the bearer of bad tidings, can be improved. If he or she resignation letter. the one to terminate an employee. participates in the solution, there is However, sometimes performance a far greater chance that a positive • Schedule this talk for 5:00 has become so marginal or change will occur. Rememberto p.m. Friday would be the best day. unsatisfactory that dismissal is a set deadlines forcorrective action. Have the payroll check ready change that is necessary. Before including vacation, sick days, and determining a course of action, • Use the checklist as a basis severance pay. (Severance pay though, you must decide if the forthis session. should be based on the reason for employee is a potentially good one termination, as well as your office who can be salvaged. The • Document accurately what policy manual guidelines.) If the following checklist should be was discussed and agreed upon. employee is vested in your helpful: This can be done in an informal pension plan, arrange to pay this memo to the employee. amount promptly. • Does the employee know Ihe requirements of the job? 2nd Conference Your decision is effective ("What? I didn't know I would be If the deadlines set at the first immediately? Itisnotwiseto required to assist the doctor. session have not been met, and if discharge an employee and allow • Did someone personally go there has been little or no him or herto remain on the over the job description, step by improvement, it is time tor a second premises longerthan necessary. step, with the employee? conference. Often a discharged employee • Does the employee actually becomes disruptive. know how to perform each task? •Clearly define your • Has someone adequately expectations in writing with a • A complete documentation trained the employee and then definite date. Include a paragraph of this conference should be determined how well the tasks that states the employee made. Ask the employee to sign it. were performed? understands that if he or she does (An employee cannot be • Does the employee really not comply, this will constitute a compelled to sign any document.) know how he or she is doing? lack of desire to remain employed If the employee refuses to sign, a ("Gee, I thought I was making the and will result in termination. witness should sign a statement appointments OK. No one ever verifying the refusal of the told me I wasn’t.") • Ask the employee to decide employee to sign the document. • Is the employee capable of if he or she wishes to remain or quit This is needed only to prove that performing these job duties? now. the employee was aware of the • Is he or she willing to perform document. the necessary job duties? • Use an ’’Employee • Was a performance review Disciplinary" form to document this • Collect the employee’s keys held with the employee three session. to the office, drawers, files, etc. months after hiring and then at least annually thereafter? Termination Conference or "Exit Now that this "mission has Interview" been accomplished," the office 1st Conference This conference is the ’’third manager should make sure that Yourgoal here is to identify strike" - now the employee is out! business is conducted as usual - or the problem and with input from even better! □ the employee, find a mutually • Point out the past promises workable solution. This is not the employee has not kept. Reprinted with permission from the Palmer Practice Management Report, accomplished by demeaning the Specifically outline offenses. Ask Jan. 1987, Diane Palmer, Executive employee. Encourage the the employee if he orshe prefers Director. employee to make

12 The Bulletin May 1987 The transfer of records of patients is subject, however, to the Medical Records following: 1. All active patients should be notified that the physician (or his The Medical Society office estate) is transferring the practice statute or regulation. A physician receives calls from physicians and to another physician who will retain should become familiar with the patients inquiring as to the custody of their records and that at applicable laws, rules or regulations accepted policy on the transfer of their written request, within a on patient access to medical medical records. AMA, WSMA and reasonable time as specified in the records. the Medical Society use as notice, the records orcopies will be The record is a confidential guidelines the "Current Opinions sent to any other physician of their document involving the physician- of the Council on Ethical and choice. Ratherthan destroy the patient relationship and should not Judicial Affairs of the American records of a deceased physician, it be communicated to a third party Medical Association, 1986." The is better that they be transferred to without the patient's prior written opinions are intended as guides to a practicing physician who will consent, unless required by law or responsible professional behavior. retain them subject to requests to protect the welfare of the from patients that they be sent to individual or the community. 7.00 OPINIONS ON PHYSICIAN another physician. Medical reports should not be RECORDS. 2. A reasonable charge may be withheld because of an unpaid bill RECORDS OF PHYSICIANS: made for the cost of duplicating AVAILABILITY OF INFORMATION for medical services. Simplified, routine insurance records. □ TO OTHER PHYSICIANS. reimbursement forms should be The interest of the patient is prepared without charge, but a paramount in the practice of Membership Benefits, Inc. medicine, and everything that can charge for complex, complicated or Medical Society of Pierce County' multiple reports may be made in reasonably and lawfully be done to conformity with local custom. serve that interest must be done by all physicians who have served 7.03 RECORDS OF PHYSICIANS If your looking for or are serving the patient. A ON RETIREMENT. physician who formerly treated a flualiQgd employees, A patient's records may be patient should not refuse for any or have other personnel necessary to the patient in the reason to make his records of that future not only for medical care but issues you need help with patient promptly available on also for employment, insurance, request to another physician litigation, or other reason. When a presently treating the patient. physician retires or dies, patients CALL Proper authorization for the use of should be notified and urged to records must be granted by the find a new physician and should be the Medical Society Office, patient. Medical reports should not informed that upon authorization Membership Benefits, Inc. be withheld because of an unpaid records will be sent to the new bill for medical sen/ices. physician. Records which may be of 572-3709 7.02 RECORDS OF PHYSICIANS: value to a patient and which are not Ask for Sharon INFORMATION AND PATIENTS. forwarded to a new physician Notes made in treating a patient are should be retained, either by the primarily for the physician's own physician himself, another use and constitute his personal physician, or such other person property. However, on request of lawfully permitted to act as a the patient a physician should custodian of the records. provide a copy or a summary of the record to the patient or to another ADVERTISE 7.04 SALE OF A MEDICAL physician, an attorney, or other PRACTICE. I N T H E person designated by the patient. A physician or the estate of a Several states have enacted deceased physician may sell to CLASSIFIEDS statutes that authorize patient another physician the elements access to medical records. These which comprise his practice, such statutes vary in scope and Call Sue Asher at the Medical as furniture, fixtures, equipment, Society Office mechanism for permitting patients office leasehold and goodwill, i.e., to review or copy medical records. 572-3709 the opportunity to take over the Access to mental health records, patients of the seller. particularly, maybe limited by 1987 May The Bulletin 13 Physicians Step Foward At Issue: Medical Care for Those Who Cannot Pay

By Mary K. Tipton

It was only a little over a year seeing patients in need of medical hours. There are times, however, and a half ago that Dr. Modarelli, care from all walks of life with when there is only one physician. Dr. Osborne, and Dr. Fouke along varying economic resources. ’There is a very real problem of with a number of other doctors Four and a half years ago, in physician burnout," says Dr. trom Pierce and King County went February, 1983, the Johnson. to Mexico City to provide medical Neighborhood Clinic at 1323 There is, as well, according to care tor earthquake victims. It was South Yakima opened its doors to Dr. Johnson, very little continuity done quietly without much fanfare. provide medical care for people of care. Clinic patients usually see The B ulletin carried their story in with no economic base to pay for a new physician every time they December, 1985. medical services. "It was a way to come into the clinic. There is a very In March of this yearthe board respond to people falling through real need to establish a referral of directors of the Community the cracks," said Dr. Ron Johnson, base of physicians to provide Health Care Delivery System current Medical Director of the follow up care for a number of honored Dr. George Tanbara for clinic. patients, especially those suffering "15 years of continuous sevice in It is a "beginning place" for a from hypertension and providing pediatric specialty care'' segment of the population that has depression. to those in need. A letter no access to health care, except "Every doctor has to decide appeared in the Tacoma News through the emergency room of a where they are on this," says Dr. Tribune from one of his patients in hospital. "A place," says Barbara Johnson But the need is clearly support of the honor. "Our family Goforth, Administrative Director for there. loves him," said the letter. "He has the Clinic, "where street people "These people need to feel they dedicated his life to care of others are treated with dignity and can take control, take charge of selflessly and is extremely humble, respect, where they gain a feeling their health, and they need to be in spite of his accomplishments." of self worth, where they don't cared for in a non threatening The lettercontinued, "We met Dr. have to face a myrad of paperwork environment where they gain a Tanbara 24 years ago because he and red tape to get medical care." feeling of self worth." served on the pediatric heart team Unlike the Community Health The clinic administration is set for Mary Bridge Hospital. How Care clinics that provide medical up to facilitate paperwork and lucky forus. He has cared forour care for families on a sliding scale, coordinate with other medical and five children, and no concern of based on their ability to pay, the social agencies to provide the ours, as parents, was too minorfor Neighborhood clinic is committed health and economic resources his attention. He always made time to the concept of a tree clinic set available to clinic patients. In many to listen, in spite of his hectic up to serve as an access point for cases, according to Dr. Johnson, schedule. ..He has helped to save an indigent population that, forthe clinic patients are unaware of the the lives of many children who are most part, goes unnoticed, except economic resources for health care now adults....He is most serious in ihe headlines of newspapers. that are available to them. but never judgemental." It was As self giving and altruistic as While medical treatment in any the perceptions of the author of the clinic may be, however, it is at a case is a system of complexities, it the letter that news of Dr. Tanbara's crossroads in its development, in a is especially true at the recognition should have appeared span of three hours, from 6:00 Neighborhood Clinic given the on page 1 of the local newspaper. p.m. to 9:00 p.m., on Monday and very nature of the population seen While front page news Thursday evenings, when the at the clinic. Those coming to the continues to focus on the clinic is open, physicians on duty clinic generally lack any sense of incompetency of doctors, at the clinic see between 30 and control over their lives and, inmost malpractice suites, the high cost of 50 patients. Most of the time, cases, are suffering from extremely medical care, physicians go about according the Goforth, there are low self esteem. A physician has the business of their daily routines, two physicians on duty during clinic to look beyond the medical 14 The Bulletin May 1987 treatment, to begin to understand three years. would also like to include outreach the motivations and thinking of the In addition to providing health education within the Clinic clinic patients. In winter months medical treatment, the clinic neighborhood to help identify when it is especially cold, their provides psychiatric care, which, in some of the health problems overriding concern is finding most cases, requires, like medical before they become serious." shelter. In orderto be effective in care, continuity and follow up. Dr. As the Neighborhood Clinic providing medical care to this Michael Pearson is currently giving takes on the growing pains of an segment of the population, the four nights a month for psychiatric established, ongoing community clinic has had to come to grips with care. sevice dedicated to providing the needs and habits of this Along with volunteer medical care to the indigent population. physicians and a psychiatrist, the population of Pierce County, other "Our hours," says Goforth, clinic is staffed with volunteer lab physicians, like Dr. Tanbara, Dr. "were set up so individuals in need technitions, pharmacists and Johnson, Dr. Osborne, Dr. Fouke, of medical treatment could come to nurses. Dr. Weatherby, Dr. Modarelli, Dr. the clinic without fear of losing their What does the future hold for Jergens, Dr. Pearson, Dr. Juarez place in line for the Shelter." the Neighborhood Clinic? This is will step forward to provide medical There is also the need to not an easy question to answer. care as required. They will do if provide medical care for individuals There is the continuing need to modestly, quietly, without fanfare, who cannot come to the clinic. develop and refine protocol, to just as they have before while talk This, in effect, means home care. establish on going continuity of of "outrageous" medical costs and To have the clinic open during care for those who require it. malpractice suites continue to daytime hours would be the ideal, There is the need for medical make front page headlines. □ according to Goforth. support from the community to Support forthe clinic has develop a larger base of physicians For information on donating services, come from the community at large. willing to take on the care of equipment, etc. to the Neighborhood Clinic, call Barbara Goforth, 272-1392 St. Joseph Hospital, St. Leo's patients at the clinic. There is the or Trudy Dodsworth, Co-Director, 627- church, and others have provided need to establish a larger base of 4741. supplies, medicines and money. volunteer physicians to service the Dr. Ron Johnson along with clinic in the hopes of preventing Dr.Robert Modarelli, Dr. Juan "physician burnout." There is the PUGET SOUND Juarez, Dr. Mark Jergens, need for the specialist to provide r m physicians from Tacoma Family continuity and follow through. COLLECTIONS, INC. Medicine and Group Health There is the growing need for 914 A Street • P.O. B ox12l3 have donated their medical primary physicians to take patients Tacoma, WA 98401 (206)383-5011 services. from the clinic, while, at the same The clinic provides treatment time, it is the primary physician who and follow-up care for minor is being economically bmsied. illnesses such as respiratory and There is the need to educate the COMPLETE ACCOUNT urinary tract infections, screening segment of the population the COLLECTION SERVICES and follow-up of hypertension, clinic is serving, to help individuals physical examinations, pap smears, identify health problems before • A C C O U N T C O LLEC TIO N S minor suturing and incision and they become serious and costly. ► ACCOUNT PRE-COLLECTION LETTERS drainage. There are the issues. What is • S K iP T R A Q N G There are times, however, quality care? What is adequate •LEGAL RECOVERY when a patient at the clinic needs care? Are they synonmous? Is • A C C O U N T F O R W A R D IN G • CREDIT COUNSEUNG SERVICES specialized care. It is at this time eveyone, regardless of economic that the physician on duty at the status entitled to medical care? clinic must face the task of finding a There is the "mission of the physician willing to take hospital" in relationship to responsibility forthe medical emergency care for this segment treatment of the patient, including of the population. There is, as follow-up procedure as needed. well, the need for a consensus in Since the clinic opened its the medical community, a need to doors in 1983 there has been a understand and establish protocol. steady rise in the numberof As for future goals of the clinic, individuals coming to the clinic according to Barbara Goforth, "we seeking medical treatment. During hope to initiate a home visitation the first year 1100 visits were made program so that we could make a to the clinic. Last year there were follow-up visit to the more seriously MEMBER: American Collectors Association 2700 visits. This is over two times ill patients in the home or hospital Washington Suite CoL)colors Association as many individuals in a little over for support and assistance, and we May 1987 The Bulletin 15 Looking Back The Royal Scribe

By Mavis Kallsen

The Pierce County Medical which sell hospital tickets or bylaws of the Medical Society as Bureau was a revolutionary thing contract with corporations forthe follows: forthe times. The Bureau, care of employees are unworthy of "Any member of this Society however, did not come out our goodwill and support. While may be summarily expelled from overnight, and the first years of its many others were of the opinion membership without a hearing by existence were tumultuous. In the that the hospitals are justified in three-fourths of all members in archives of the Medical Society of making these financial good standing present, upon the Pierce County there are old arrangements. following grounds: conviction of a ledgers and documents sketching "At 11 p.m., the Society felony, willful fraud in his the onset of contract practice and adjourned to the supper room credentials, an openly immoral life, events leading up to the where a bountiful repast was public conduct of extreme revolutionary Pierce County spread. The toastmaster for the indecency or the taking of "lodge Medical Bureau. The years 1917 evening, in his clever and work" or "contract work," or such through 1919, the first years of the interesting way, managed and other notoriously irregular conduct Bureau, we have recorded by the preserved order while inviting as a citizen or physician as would Society's most articulate scribe, those present to respond to toasts make his presence undesirable in Doctor Royai A. Gove. in a very able manner...adjourned the interests of public or Doctor Gove must have had a at 1:30 a.m." professional morality or decency." feeling for history. He saved The next discussion of the After weeks of argument, with everything and entered his own contract practice concept was at a few alterations and propositions remarks into the record, providing a the Medical Society's meeting of by Doctor E.M. Brown, Case's humanistic view of the perilous January, 1905, when Doctor Case amendment was adopted by the early life and times of the Pierce "made a few remarks." Doctor Medical Society...The "contract County Medical Bureau. Thomas Curran, an employee of doctors" scattered. January, 1906, In the beginning, the Yocom's was asked to report on the old guard...Doctors Shaver, objections to contract practice this subject and two weeks later Dewey and Love were elected entered early in the Medical read an interesting paper on officers of the Medical Society and Society of Pierce County, but were "Hospital Contract Work," asserting Case, Read and Brown appointed handled in a courtly manner. In that ..."Whereas, during all the chairmen of the standing 1890, Doctors Dewey and Shaver years the members of the medical committees. It became a Society of protested to the trustees against profession have given their old men...standing erect against the contracting by Fannie Paddock services to the said hospitals for the tides of the new medicine and Hospital for treatment of "other such cases absolutely free..." quarreling amongst themselves than pauper patients." but no We also have in our archives over trivia. action was taken. documents showing the That year, 1906, another "old April of 1898 a special meeting physicians were paid under these man" joined the Medical of the Medical Society of Pierce contracts in accordance with the Society...Royal A. Gove, a County was held in the Whist Club fee schedule set by the Medical graduate of the College of Rooms of the Hotel Donnelly. The Society of Pierce County. As Physicians and Surgeons at subject of discussion for the Doctor Curran concluded... Keokuck, Iowa in '78. Like Doctor evening was the financial contract practice was an intricate Case, he was admitted to management of the hospitals in proposition. membership in spite of his relations to the welfare of the In November, 1905, when sectarian schooling, but without medical profession. As recorded in Doctor Case made his charges controversy, as he was a non- the minutes... against Yocom, Wagner and Hicks, controversial man of even "Many of those present were he also submitted a proposed disposition. Doctor Gove set about of the opinion that those hospitals amendment to the constitution and creating order out of chaos with the

16 The Bulletin May 1987 Western and Bridge Clinics. Three carried. Medical Society members were "Whereas a medical aid law has Medical Society, urging expelled doing bdge work. been passed in this state which moderation and compromise, and Eighteen members were dropped provides and legalizes a contract two years after he joined the for non-payment of dues. system and individual choice of Society he became its president. In May of 1917, the State physicians for medical and hospital The year following his term as Legislature passed an Industrial care of injured workmen; and president, he was elected the Insurance Act known as the "First whereas it is manifest that the Society's treasurer and was re­ Aid Law," permitting compensation contract practice shown will be elected continuously to that post for healthcare contracted by permanent... until in 1917 he was elected physicians with probated payment. "Therefore be it resolved that secretary-treasurer and served in The passage of this Act was in the Medical Society of Pierce this office until his death in great part due to the efforts of a County, for the best interest of its January, 1920. number of Pierce County members, organize an industrial During his year as the Medical physicians. service bureau supervised by the Society president, Doctor Gove The Medical Society Board of Trustees of the Society, instituted a degree of definition immediately took advantage of the which Bureau will have full powers between "contract work" and opportunities presented by the to make contracts forthe Society "lodge contract work," permitting new law. Doctor Gove gave this with employers and employees the great numbers of contract account of a special meeting called and to supervise the management physicians in the County to again May 29th, 1919... of such Bureau. take part in the Society's activities. 'The purpose of the meeting "Be it futher resolved that The Medical Society took a was to discuss and take action such Bureau be operative at bold public stand against "lodge upon the desirability of the Society once." work" and the following appeared itself entering into Industrial When it was incorporated two in the Tacoma Ledger in January, Insurance Contracts underthe new weeks later, the Bureau was 1912. First Aid Law. The following Continued on page 18 resolution was unanimously LODGE CONTRACT DOCTORS PARIAHS The Medical Society of Pierce County will make outcasts of them after April 1st...Such practice Manor Care scored. "Physicians engaged in lodge of Meadow Park contract medical practice will be CONVALESCENT AND REHABILITATION CENTER pariahs among eithical doctors in Tacoma after April 1st. So • 24 Hour Skilled despised and hated will they be Nursing Care that any member of the Medical Society who shall even deposit • Long-Term and with any physician doing lodge Vacation Stays contract practice will be expelled from the Society. In addition to this the Society determined to take • Occupational, active steps immediately to Speech and exclude after April 1st. physicians Physical Therapies doing lodge contract work from entering or treating patients in the • Medicare Certified hospitals. Cheapening of the medical profession, together with • Deluxe Heritage advantages taken of such practices Wing by ingenious individuals and lodge organizers is alleged in the For more information contact our Admissions Director committee report." Only the Elks continued to contract directly for physicians 4 7 4 - 8 4 2 1 services with the charges included 5601 S. ORCHARD ST. • TACOMA in membership dues, but a number of private "Clinics" sprang up in Medical Director, John Atkinson. M.D. town to jion the well established

1987 May The Bulletin 17 way to obviate having two or three she had gotten no work and men get the most of the money considered the $5 she had paid for financed by the offering of $1000 was to divide it evenly at the end of stock to be a total loss! work of stock at $5.00 per share, the month among all the members At the meeting of October, with an original ten shareholders in of the Bureau who were in active 1918, the matter was again at 20 shares each. It was practice. discussed... incorporated to..."own, operate Dr. Robertson offered his Dr. Houda moved that no and conduct hospitals, drugstores opinion that this course would not physician shall draw more than and medical dispensaries, be forthe best interests of the $100 a month for his services ambulances and ambulance Bureau. through the Bureau." service." Dr. McCreery stated that he Dr. Kunz stated that it was only The Bylaws read as follows: believed that getting the work by fair for the physician doing the work 'The intention of this company is the members of the Bureau was to be paid for all he had done. not primarily for profit, but to secure largely a matter of personal Dr. Houda argued that if one to the members of the medical friendship, and pointed out that man had much the largest amount profession who are stockholders of Kunz was a good friend of the of work, he should turn over the this company, the right to practice shipbuilding company's personnel balance to some other member of their profession in conjuction with director. the Bureau. the so-called First Aid Law of the Dr. Houda remarked that the Dr. Bell's opinion was the fault State and to make contracts with weakest part of his corporation was lay with the industrial plants, and employees of labor and their the possibility that some doctor that the plants should distribute employers for service under such could arrange it so he got most of cases evenly. First Aid Law and for services the business, and perhaps a The motion was made and outside the First Aid Law and to central Bureau within the Bureau carried that cards be printed listing use this corpoation as a means of could be arranged so that the work the physician members of the contract and collection." could be more evenly divided. Bureau, and distributed to the men Doctor Royal Gove, Secretary- Dr. Mary Perkins stated that at the industrial plants so that they treasurer of the Society, then was elected Secretary-treasurerof the Bureau. In September, in his first quarterly report, he noted the slow process of obtaining contracts. A month later it was reported that the THE DOCTORS’ EXCHANGE Bureau had received $285 from ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY the sale of shares to 57 doctors, and that an agent was appointed for solicitation of contracts ona commission of 40% of the first month's collections. ..Another First In April, 1918, Doctor Gove reported that there were not 2,500 Why settle for just patients under contract with the a phone number? Bureau. He then referred to the fact that the Bureau, when With the new organized, was formed for the Information purpose of "providing a means so Display Pager that all physicians in Tacoma who you can receive belong to the Bureau would get a patient name, share of the work," and nature of call added..."Experience, however, AND telephone No. has shown that it has been very INSTANTLY! unevenly divided: one physician in particular, Dr. Kunz, has gotten Office: 272-4111 much the largest share." (Kunz was Exchange: 272-3166 not present at this meeting). Locally owned and operated. Dr. LaGasa then stated that one of the reaons he (LaGasa) 908 Broadway, Suite 201 secured the larger share of the Tacoma, WA 98402 work was because he had longer office hours. Dr. Hunter suggested that one

18 The Bulletin May 1987 could make their own choice of physicians..."in accordance with provisions of the First Aid Law." The Police Contract was also Allenmore discussed, and it was decided that there were "too many chronic ailments among the policemen to make this contract a paying Medical Center proposition and that it is better not to try to make a new contract." At the annual meeting held Pierce County's most prestigious medieal/dental facility. 22 acre campus adjacent to the 156 bed Humana Hospital, October, 1919, Dr. Gove Tacoma. Central location, easy freeway access. All inclusive submitted his report as treasurer of rental rates with suite construction allowances available. the Bureau...noting that the business done by the various doctors of the Bureau during the • Limited number of medical/dental year had totalled $13,569.05, and suites now available disbursements among the 62 doctors were listed. The amounts received by the first three doctors were as follows: Dr. Kunz $3,042; (206) 383-2201 Dr. LaGasa $1,635; Dr. (206) 383-2086 McNerthney $1,354.50. The next highest amount was $397.50 paid to Dr. Quevli. Dr. Gove then made his last remarks as Secretary of the Julie Labrecque, CPM, Business Manager S. 19th & Union • Suite B-1005 • Tacoma, WA 98405 Bureau..."Gentlemen, a survey of our work since organization of the Bureau demonstrates that the purpose for which it was formed, namely, the securing of a share of o the industrial work which otherwise would have been taken over by two or three contract physicians of o Tacoma, has been eminently Medical Office Management successful." □ o Systems and Software Reprinted from: The Bulletin, 1976. with a special thanks to Larry Evoy and Hugh Williamson for providing o M e d - P a k access to the old Bureau ledger.

o "It will do what you want it to do!” 100% chance of success FIELD DAY o "THE FUTURE" - Plan for Sept. 25th 321 Meridian S Puyallup, WA Doctors, Lawyers, Dentists o Mon-Fn 10-6, Sat 10-5 845-9673 Golf, Tennis, o Over 18 years experience in Medical Office Running and Management to help solve your needs Bridge Tournament o Featuring Epson Equity Series For details call the Medical Society Office 572-3667 o

1987 May The Bulletin 1S The Fable of Aesculapius and the DRaGons By Bruce W. Jafek, MD

Once upon a time, in a far away his trusted "enforcers." As the But he found that the wiser King land, lived a well intentioned.but knights and DRaGons did battle, Hugh Manna wanted only the often bumbling King Sam. Sam asked for even more hearty subjects and the stronger Sam had a dedicated group of loyal voluminous reports from the battle knights, and wanted nothing at all knights, clad in white, of course, to fields. Analyzers were hired to do with DRaGons or soothsayers distinguish the"good guys," led by (known only by mysterious (although they would accept a few the valiant Sir Aesculapius. names,such as PRO, and the like) clerks). Aesculapius led the knights hither with improved crystal balls and Finally, Sam called the leftover and yon to confront the kingdom's offered charts and graphs to the DRaGons, analysts, and problems, often donating his time soothsayers as to the accuracy of soothsayers to the castle to reveiw to help the older or poorer the reports. Extensive reports all the reports. But the fire members of the kingdom. And all were analyzed, filed, and breathing DRaGons set fire to the was well in the land. preserved in the castle. Soon, the reports, burning the castle and One day King Sam decided to knights and DRaGons were so injuring many subjects, leaving improve the tot of his subjects by busy reporting and the analyzers Sam bereft of resources. Sam and paying for increased knight care. and soothsayers so busy analyzing the subjects yearned forthe "good He called his program "Sam Cares" that no one was about to help the old days" when friendly sir forthe older subjects and "Sam subjects. And all was less well in Aesculapius journeyed through Aides" for the younger, poorer the land. the kindom helping the needy. But subjects.Sir Aesculapius and his Next Sam accused the all was chaos in the kingdom. colleagues, the Associate DRaGons of not being complete; M oral of the story: DRaGons will Members of Aesculapius (AMA) he accused the knights of using always be draggin' and wont help warned mightily of the cost of the lances that were too sharp, too subjects get better knight care. program, but King Sam prevailed, fancy, ortoo expensive. He dubbing his idea the "Great accused the analyzers of being too Society." And all was in turmoil in numerous and manipulating the Reprinted from EAR, NOSE and the kingdom. reports for personal gain. He hired THROAT journal, Vol 66, Feb. 1987. To begin his program, Sam more soothsayers, required more Bruce W. Jafek, MD, is chairman, decided to provide a knight for reports, and wondered why the Department of Otolaryngology/Head each village, but a soothsayer with costs mounted. All was less well in and Neck Surgery, University of Colorado School of Medicine, Denver, a crystal ball reported that there the land. Colo. were not enough knights to go In desperation, Sam tried to sell around. So Sam proclaimed a everything to a neighboring king. shortage and built new knight schools. But the new knights stayed in the castle. And the villagers were still without knights. Computerized Testing And Sam levied new taxes on his ( k e c v it people to pay for his increasingly By F a ste st G tv u p e r u f, expensive program. And all was Psychological, Vocational, less well in the kingdom. Educational To control his new knights, and Adult, and Children new knight schools, and other aspects of the increasingly Harold B. Johnston, MD, P.S. expensive knight care, Sam Union Avenue Pharmacy Allenmore Medical Center, B-3009 sought out a group of DraGons (in & Corset Shop South 19th & Union consulation with his soothsayers, 2302 S. Union Ave., Tacoma Tacoma, WA 98405 Telephone 383-2413 of course) and had them become ______752-1705

20 The Bulletin May 1987 Thank You strollers are welcome, and if it is a nice day, they"ll love it! Plan to Myrna Nagle & bring your potluck dish of salad, Featuring sandwiches, or even a casserole Tacoma's Finest Homes Susie Wiese and relax with old and new friends A big thank you is long before the busy (or lazy) times of overdue to both Susie and Myrna Richard C. Pessemier summer catch up with us. Sales A ssociate for coordinating the coalition for It promises to be a fun day! the Fashion Event which was held Look for further announcements in 27.!-II 38 Of I icr 759-JW9 HOMF at the Tacoma Dome, March 18. It the "PULSE" or call Rubye Ward, was a huge success, and they did 272-2688; Alice Yeh, 565-6929 or Swanson-McGoldrick, Inc. an outstanding job! Thank you! Mimi Jurgens, 1 -851 -5720 for WASHINGTON IK II CUM', si ||f. {nj IAfOM.\ v\ AMIIM.JON reservations. There will be signs Nominating directing you to the exact meeting Committee spot inside the Beach Park. Report On Feb. 2,1987, the following slate of officers was presented to Fircrest and approved by the PCMS Auxiliary Board members. Lakewood President, Bev Graham President-Elect, Kris White Parkland 1st Vice President, Program, Mary Lou Jones 2nd Vice President, Spanaway Membership, Candy Rao 3rd Vice President, Bylaws & Historian, Joan Iverson Steilacoorn 4th Vice President, Arrangements, Nancy Rose Univeisity Place Recording Secretary, PatK esling

Corresponding Secretary, B ev Law With a brand new Lakewood Health Care Campus, residents of Treasurer, Alice Yeh surrounding communities can look forward to a future of excellence Dues Treasurer, Helen Whitney in health care. The new complex will be built on a 23-acre site near 112th Street and Bridgeport Way, still close enough to offer the Potluck and Special security of neighborhood health care 24 hours a day. And Lakewood Walk coming up M ay Hospital's 25-year-old standards of personal care will be retained. You can count on that. On Friday, May 15, a special walk and potluck lunch are planned forthe last Auxiliary meeting of the LA K EWOODlLil: h o s p i t a l

year. It will be held at Titlow Beach I h i D i i h i i l i i ’i: L o u h u u f', Park, 8355 6th Ave., Tacoma. We'll begin our walk at 10:30 a.m. with lunch to follow. Kids and

1987 May The Bulletin 21 Membership

In accordance with the Bylaws of the Medical Society of Pierce County, Chapter Seven, Section A, MEMBERSHIP, the following physicians have applied for membership, and notice of their application is herewith presented. As outlined in the Bylaws, any member who has information of a derogatory nature concerning an applicant's moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of the Society.

William J. Crabb, John E. Bruce, D.O. Lawrence A. Price, MD, MD., Emergency Emergency Medicine. Family Practice. Born Medicine. Born in Born in Spokane, in Berkeley, CA, Spokane, WA 11/6/ WA, 5/17/52; Univ­ 2/12/41; McGill 50; University of ersity of Health University, 1966; Oregon Health . Science College internship, St. Sciences, 1978; of Osteopathic Luke's Roosevelt internship, Maricopa Medical Center, 1 - ■ " Medicine, Kansas Hospital, 7/66-6/67; City, MO., 1980; internship, William 7/78 - 6/79; residency, Maricopa Medical residency, St. Luke's Roosevelt Center, 7/79 -6/80, radiology; Beaumont Army Medical Center, 7/80 - Hospital, 7/67 - 6/68; Washington State 6/81; residency, Brooke Army Medical Washington State License, 1986. Dr. License, 1987. Dr. Price is currently Crabb is currently practicing at 315 Center 7/82 - 6/84; Washington State practicing at 721 S.Fawcett, Tacoma South K St., Tacoma. License, 1985.

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22 The Bulletin May 1987 705 South Ninth Street • Suite 203 • Tacoma, Washington (»H4^)5 • IHcphnnr 572-.'ifrf»! GENERAL MEMBERSHIP MEETING

Tuesday, May 12, 1987

(Sanctions...PRO’s and HCFA...Laws and Regulations Pre Admission Review...Morbidity/Mortality)

Speaker: Mr. Larry Camp Chief, Medical Review Branch, Division of Health Standards & Quality Health Care Finance Administration (HCFA)

DATE: Tuesday, May 12,1987 TIME: 6:00 p.m. No host cocktails 6:45 p.m. Dinner 7:45 p.m. Program PLACE: Executive Inn (5700 Pacific Highway E.) COST: $14.50 per person

Register Now. Space w ill be limited. Please complete the attached reservation form and return it, with a check for the appropriate amount, made payable to the Medical Society of Pierce County, in the enclosed pre-addressed envelope, or call the M edical Society O ffice, 572-3667, to confirm your attendance.

Reservations must be made no later than Friday. Mav 8

REGISTRATION:

Yes, I (we) have set aside the evening o f M ay 12, to jo in m y fellow Society members fo r the presentation of Mr. Larry Camp.

□ Please reserve dinner(s) at $14.50 per person, (tax and gratuity included)

Enclosed in m y check fo r $______

□ I regret that I am unable to attend the dinner portion of the meeting. I w ill attend the program only.

Dr.

RETURN TO MSPC NO LATER THAN FRIDAY, MAY 8 Classifieds Pacific Northwest Opportunities - We Used Medical Equipment. Exam have openings in the Pacific Northwest Tables, electric minor surgery table, and California. Let us assist you. No centrifuges, vision tester, hemoglobin Physician Needed fee to physician. Call or send CV to : and bloodsugar machines, uterine Archelle Reynolds, Western States evacuation suction machine, Physician Service, 9605 Sunrise treatment stands, cervical dilator, vag. Family Practice - Excellent opportunity Beach DR. NW, Gig Harbor, WA 98335. speculum and more. Very good with Seattle's leading provider of (206) 851-6201. condition and prices. For written Family Practice. Positions available inventory and price list contact B. throughout greater Seattle. Current Earling, 3775 Southwest 319th St., license BC/BE in family practice. Practices Available Federal Way, 98023, or call 838-5134. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Ave., MD, Internal Medicine - BC/BE to take #225, Seattle, 98121, Debbie Phillips over established practice in SW King (206) 728-6888. County. Call Administrator. 248-4550. Office Space Available

Immediate Openings- Full time and Professional Offices for rent - part time positions and Directorship in Positions Wanted Advantages: good parking, close to Tacoma acute illness clinic. Hourly hospitals, minimal rents, lab and X-ray rates plus excellent malpractice. Board certified general internist - 40, in building. Call Dr. Moosey 383-1717 Flexible scheduling. Any state seeks practice opportunity in the or383-1718. license. Other opportunities including Tacoma area. Group arrangement ER in Olympia area. Call NES 1-800- preferred. Would also consider Office space available to share - Ideal 554-4405, ask for Ginger. summer of full year locum tenens or for satellite or full time small office in practice swap (Northern California). Federal Way on Pacific Highway, close Physician Opening - Ambulatory Reply to Internist, P.O. Box 927, to I-5 exit. Phone 927-2260. care/minor emergency center. Healdsburg, CA 95448. Full/part time for FP/ IM/ EM trained, experienced physician. Located in Equipment Tacoma area. Flexible scheduling, General pleasant setting, quality medicine. Retiring? Call us regarding surplus Contact David R. Kennel, MD, at 5900 equipment. Call 453-8892. Floral Arrangements - For your 100th St. SW, Suite 31, Tacoma, WA convenience, fresh floral 98499. Phone (206) 584-3023 or 582- Office Equipment arrangements are available for delivery 2542. Retired physician, All proceeds go to at Tacoma General and Mary Bridge. St. Leo's Neighborhood clinic. Call the Tacoma General Hospital Gift Shop, Wanted, Family Practitioner or Medical Society, 572-3667. 594-1000. Internist - No purchase necessary - Outstanding immediate opportunity to Surplus Medical Equipment. Large Accounts Receivable Up - or Mixed step into an active practice! High inventory of diagnostic, office and Up? Cash flow down? CallSERECO volume private practice located in home care equipment. Prices Associates to help you find out why. prime medical office/hospital campus. extremely reasonable. Call Lynda We are specialists in retrival with Steady referrals through inhouse (206) 453-8892. management techniques for marketing program. This may be hard bookkeeping, office management, to believe but it’s true! Washington Auction. Large six-hospital surplus insurance claims, accounts receivable State Physician Certification is equipment auction. Medical/surgical, and payable. (206) 927-6540. required. Please contact Hugh laboratory, patient care equipment, Hendrix at (206) 474-0561, ext. 579. dietary, much more. June 6,1987. Puget Sound Hospital, Tacoma, WA Seattle, WA. Call (206) 453-8892 or 98408. (206)839-9696.

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Kefiet is contraindicated in patients with known allergy to the cephalosporins and should be given cautiously to penicillin-sensitive patients.

'987, DISTA PRODUCTS COMPANY cephalexin

Brief Summary. Consult the package literature for nonsusceplible organisms. Careful observation of the patient is prescribing inform ation. essential. II superinfection occurs during therapy, appropriate Indications and Usage: Kellet'“ Tablets (cephalexin, Dista) measures should be taken. are indicated tor the treatment of the following infections when Positive direct Coombs' tests have been reported during caused by susceptible strains of (he designated treatment with the cephalosporin antibiotics. In hematologic microorganisms studies or in transfusion cross-matching procedures when anti- Respiratory tract infections caused by Streptococcus pneu- globulin tests are performed on the minor side or in Coombs' mowae and group A/3-hemolytic streptococci (Penicillin testing of newborns whose mothers have received cephalospo­ is the usual drug of choice in ihe treatment and prevenlion rin antibiotics before parturition, it should be recognized that a of streptococcal infections, including the prophylaxis of positive Coombs' test may be due to the drug. rheumatic fever Keflet is generally effective in the eradi­ Keflet should be administered with caution in the presence of cation of streptococci from Ihe nasopharynx; however, markedly impaired renal function. Under such conditions, care­ substantial data establishing the efficacy of Keflet in the ful clinical observation and laboratory studies should be made subsequent prevention of rheumatic fever are not available because safe dosage may be lower than that usually recom­ at present) mended. Otitis m edia due to Spneumoniae. Haemophilus mlluentae. Indicated surgical procedures should be performed in con- staphylococci, streptococci, and Neisseria catarrhahs lunction with antibiotic therapy Skin and skm-structure infections caused by staphylococci As a result of administration of Keflet, a false-positive reac­ and/or streptococci tion for glucose in the urine may occur This has been observed Bone infections caused by staphylococci and/or Pro/eus with Benedict's and Fehting's solutions and also with Clinilest- mi/dbihs tablets but not with Tes-Tape1-1 (Glucose Enzymatic Test Strip, Genitourinary tract infections, including acute prostatitis, USR Lilly) caused by Escherichia coli. Pmirabihs, and Klebsiella sp. Broad-spectrum antibiotics should be prescribed wilh cau­ Note— Culture and susceptibility tests should be initiated tion m individuals with a history of gastrointestinal disease, prior to and during therapy Renal function studies should be particularly colitis performed when indicated Usage in Preqnancy- Pregnancy Category B— The daily oral C ontraindication; Keflet is contraindicated in patients with administration of cephalexin to rats in doses ol 250 or 500 known allergy to the cephalosporin group ol antibiotics mg/kg prior to and during pregnancy, or to rats and mice during W a rn in g s : b e f o r e c e p h a l e x in t h e r a p y is in s t i t u t e d c a r e f u l the period of organogenesis only, had no adverse elfect on INQUIRY SHOULD 3E MADE CONCEDING PftfcVlOljiHYPERSENSIMVlTY fertility, fetal viability, fetal weight, or litter size Note that the REACT 'ONS TO CEPHALOSPORINS AMD PEMCHCIN CEPHALOSPORIN C OERiVA- safety of cephalexin during pregnancy in humans has not been T l'JE S S H O U LD BE G IV E N C AU TIO U SLY 10 f-ENIClLllN-SEHSlTlvE PATIENTS established SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPlNfPHfllNE Cephalexin showed no enhanced toxicity in weanling and AND OTHER EMERGENCY MEASURES newborn rats as compared wilh adult animals. Nevertheless, There is some clinical and laboratory evidence of partial because the studies m humans cannot rule out Ihe possibility cross-allergenicity of the penicillins and the cephalosporins of harm, Keflet should be used during pregnancy only if clearly Patients have been reported to have had seveie reactions needed (including anaphylaxis) to both drugs Nursing Mothers— The excretion of cephalexin in the milk Any patient who has demonstrated some form of allergy, increased up to 4 hours after a 500-mg dose, the drug reached particularly to drugs, should receive antibiotics cautiously No a maximum level of 4 ^g/m L, Ihen decreased gradually, and excephon should be made with regard to Keflet had disappeared 8 hours after administration Caution should Pseudomembranous colitis has been reported with virtually be exercised when Keflet is administered to a nursing woman all broad-spectrum antibiotics (including macrolides, semi- Adverse Reactions: Gastrointestinal'-Symptoms ol synthetic penicillins, and cephalosporins), therefore, it is pseudomembranous colitis may appear either during or after important to consider its diagnosis m patients who develop antibiotic treatment Nausea and vomiting have been reported diarrhea in association with the use ol antibiotics. Such colitis rarely The most frequent side elfecl has been diarrhea It was may range in severity from mild to life-threatening very rarely severe enough to warrant cessation ol therapy Dys­ Treatment with broad-spectrum antibiotics alters the normal pepsia and abdominal pain have also occurred. As with some flora ol the colon and may permit overgrowth of Clostridia penicillins and some other cephalosporins, transient hepatitis Studies indicate that a toxin produced by Clostridium dilhcile is and cholestatic jaundice have been reported rarely. one primary cause ol antibiotic-associated colitis Hypersensitivity—Allergic reactions in the lorm ol rash, urti­ Mild cases of pseudomembranous colitis usually respond to caria, angioedema, and, rarely, erythema multiforme, Stevens- drug discontinuance alone In moderate lo severe cases, man­ Johnson Syndrome, or toxic epidermal necrolysis have been agement should include sigmoidoscopy, appropriate bacte- observed These reactions usually subsided upon discon­ nologic studies, and fluid, electrolyte, and protein tinuation of the drug Anaphylaxis has also been reported supplementation When Ihe colitis does no! improve alter the Other reactions have included genital and anal pruritus, drug has been discontinued, or when it is severe, oral van­ genital moniliasis, vaginitis and vaginal discharge, dizziness, comycin is Ihe drug ol choice for antibiotic-associated pseudo­ faligueand headache. Eosinophilia, neutropenia, throm­ membranous colitis produced by C difficile Other causes oi bocytopenia, and slight elevations in SGOT and SGPT have colitis should be ruled out been reported Usage m Pregnancy■ - Safely of this product lor use during 'II I'H pregnancy has not been established Siurat.i Precautions: General- Patients should be followed carefully so that any side effects or unusual manifestations ol drug Additional informal w available lo theprolession on request Irom idiosyncrasy may be detected. II an allergic reaction to Ketlet Dista Products Company occurs, Ihe drug should be discontinued and the patient treated Division of Eli Lilly and Company with the usual agenls (eg, epinephrine or other pressor amines, Indianapolis, Indiana 46285 antihistamines, or corticosteroids). Mfd by Eli Lilly Induslries, Inc Prolonged use of Keflet may result in the overgrowth of ■ " ' Carolina, Puerto Rico 00630 PHYSICIANS INSI TRANCE WASHINGTON STATE PHYSICIANS iNSUR*UCF f >0'MIG6 f. AiSOCI*'

ASSETS POLICYHOLDERS PREMIUMS P h ysicians Insurance was creatcd in 1981 with the following goals:

• Quality Protection • Dividend Savings • Superior Service • Aggressive Defense • Selective Underwriting 9 Low Administrative Costs • Physician Inpul and Control

With these goals in mind. Physicians Insurance has become the largest underwriter of Professional Liability coverage in the state. To determine if you qualify for coverage or to request additional information, contact: Tom Fine, V.P Physicians Insurance 2033 Sixth Avenue Seattle, WA 98121 (206) 728-5800 1-800-732-1148

What’s new for physicians at St. Joseph Hospital?

♦ Mobile Lithotripsy U nit for non- ♦ Tacoma Treatment Center for com­ surgical treatment o f kidney stones; prehensive outpatient care o f oncol­ service begins this spring. ogy patients and others needing IV therapy. ♦ CT Q uick Scanner (GE 9800 Quick) and complementary software, unique ♦ Home Health Service providing a in the Puget Sound region; low-cost, range of services w ithin the home set­ accurate osteoporosis screening; 3-D ting at lower cost than hospitalization. reconstruction for craniofacial recon­ struction and orthopedic surgery.

St. Joseph Hospital a physician partnership For more information, call 591-6767. 705 South 9th« Suite 203 b u lk k a il Tacom a, W ashington 9 8 i 0 5 U.S. POSTAGE & PAID AL>I.)KI:V-'( < >KR1-.(..'I K )N HI'.Qf 'HSTKD TACOMA, WASH PERMIT NO. 60S _l MSPC

r Tw- r r: Y- ♦/4 publication of fog Medical Society of Pierce County

VOL. 2, NO. 5 705 South 9th, Suite 203 JULY, 1987 Tacoma, Washington 572-3667

REGISTERED TO VOTE?? HOW IS INITIATIVE 92 GOING If you don’t know where to INITIATIVE 92! ! TO IMPACT YOUR PATIENTS, register, call the Medical YOUR PRACTICE, YOU, YOUR Society for the nearest Many critical issues will FUTURE? THINK ABOUT IT. place to register. If you face the voter stepping IT SHOULD BE WORTH THE have recently moved, just into the voting booth EFFORT TO GO AND REGISTER call the Election Depart­ November 3. One of them TO VOTE. will be INITIATIVE #92. ment, 591-7430 to have Initiative 92 would make it your records transferred a violation of the Consumer without having to re­ Protection Act for a register. 1987 WSMA ANNUAL MEETING medical doctor, osteopath, TACOMA SHERATON chiropractor, podiatrist, If you would like an SEPTEMBER 17-20 dentist, or optometrist to absentee ballot drop by or charge a Medicare-eligible write: Pierce County Plan on attending the 1987 patient in excess of Election Dept., 2401 South WSMA Annual Meeting to be Medicare’s "reasonable"- 35th St., Room 200, held in Tacoma, September charge for that service and Tacoma, WA 98409-7484, 17-20. The House of to fail to enroll, or con­ Delegates will convene at tinue, as a "participating" 1:30 p.m., Thursday, physician if treating INITIATIVE 92 September 17; with the Medicare-eligible patients. second session Saturday As stated in the above morning and afternoon, Seniors and disabled people article, on November 3, September 19; and final who have health insurance Washingtonians will vote on session Sunday morning, other than Medicare or want Initiative 92. September 21. to pay their own bills will not be able to see a WSMA Board of Trustees and All members are invited to physician who chooses not staff have prepared a attend and see Democracy in to participate in the packet of information on action. The Reference Medicare program under Initiative 92. You will be Committees will meet Friday Initiative 92. receiving it in early July. morning, September 18. Every vote will count. This is an opportunity to Will yours? If you are Please read it and become voice your opinion on not a registered voter, familiar with it. issues of importance to please make an effort to you. REGISTER 30 days prior to It is important that you If you would like to submit the election and at least start talking to your a Resolution for introduc­ 45 days prior to the patients on the impact of tion to the House of election if you will be this Initiative. This is a Delegates, please submit it voting on an absentee matter that should be a to the Medical Society ballot. federal issue rather than office prior to August 1. decided at the state level. Continued on Page 9 MSPC NEWSLETTER JULY, 1987 POSITIONS AVAILABLE

The Department of OB/GYN at Madigan Army Medical Center, Tacoma Washington has an immediate opening for the civilian position of Medical Officer (OB/GYN). Beginning salary is $55,225 per annum. Incumbent has responsibility for the examination, diagnosis and treatment of the full range of outpatients seen in the clinic. Performs minor office surgical procedures such as endometrial biopsies. Contact Kathleen Derry at Fort Lewis Civilian Person­ nel Office at (206) 967-2131 for further information and govern­ ment application forms.

WESTERN CLINIC, a large multispecialty clinic, is seeking physicians for the following positions: Family Practice at Port Clinic Facility - No night or weekends; no OB. General Internal Medicine - at Tacoma facility. Ob-Gyn - for both Tacoma and Gig Harbor facilities. Family Practice with OB - at Tacoma facility. All positions offer excellent starting salary, fringe benefits, and partnership potential. Contact William Brand, M.D., c/o the Western Clinic, 521 South "K" Street, Tacoma, WA 98405, 206-627- 9151 .

FAMILY PRACTICE - Excellent opportunity with Seattle’s leading provider of Family Practice, Positions available thru out greater Seattle. Current license BC/BE in family practice. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Avenue, #225, Seattle 98121, Debbie Phillips (206) 728-6888.

Full time position available for general practice M.D. in Gig Harbor Clinic, affiliated with G.H. physicians, needed by August 1987. Contact James Patterson, M.D. (206) 851-5121.

Physician Opening. Ambulatory care/minor emergency center. Full/Part time for FP/IM/EM trained, experienced physician located in Tacoma area. Flexible scheduling, pleasant setting, quality medicine. Contact David R. Kennel, M.D. at 5900 100th Street S.W., Suite 31, Tacoma, Washington 98499. Phone (206) 584-3123 or 582-2542.

Lakewood Hospital, South Puget Sound, recruiting for associates in: FAMILY PRACTICE and INTERNAL MEDICINE: is a 95-bed acute care surgical, medical and obstetrical hospital which has a new facility due for early ’88 completion. In addition, a very busy associate physician wishes to retire from his solo practice in INTERNAL MEDICINE. This practice, which was established and has run consistently since 1966, is for sale. BC/BE respond to Genie Latta, Physician Recruitment, Lakewood Hospital, 5702 100th St. S.W., Tacoma, WA 98499-0998, (206) 588-1711.

Family Practice Physician - 2 full time positions in growing community health center in King County. Competitive salary, malpractice paid by employer, deferred compensation plan avail­ able, health benefits. First position in Auburn/Federal Way area

MSPC NEWSLETTER 2 JULY, 1987 Continued from Page 2

and includes some low risk obstetrics. The second position is in Bellevue and currently includes no obstetrics. Provide com­ prehensive range of primary health services to patients of all ages, in patient care as required, nurse practitioner consulta­ tion, participate in a shared call system. Board eligible or certified in family practice. Send resume or VITA to SKCCHC 1025 South 3rd, Renton, Washington 98055 or call Jim Bauman or Molly Lanegraff at 206-226-7039.

Immediate Openings - Full time and part time positions and directorship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice, flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1- 800-554-4405 ask for Ginger.

______MILES TO GO!! St. Mary’s in Glacier If you would like to help Dr. Dave Pomeroy, Gig National Park. Dave reach the $10,000 Harbor Family physician, mark, you can send your tax who is biking his way He did say that Stevens deductible contribution to across America, called the Pass was a challenge, but his office at: 5122 Olympic Society office on June 10 the stiff head-wind from Dr. N.W., #203, Gig Harbor, to say all is going well. Coulee City to Spokane (100 WA 98335. He expressed his thanks to miles) was a bit tiring. all those who pledged The riders have been contributions enabling him averaging 80-85 miles per to make the trip. day.

The group of 190 riders The trip organization has who have pledged over 1.2 been superb, Dave reports, million dollars to the with excellent back up American Lung Association support for the riders. were into their second week of riding. They Dave has been one of the expect to arrive in more successful fund Atlantic City, New Jersey raisers among the riders. on July 16. He says he is just $1,000 short of reaching $10,000 Dave reported that the and wants all of his weather has been beautiful colleagues and supporters and he was preparing to to know that he is still WAMPAC pitch tent that evening at accepting pledges.

Continued

ADVERTISING AND NEWSLETTER COPY MUST ARRIVE IN THE SOCIETY OFFICE BY THE 15TH DAY OF THE MONTH PRECEDINQ THE PUBLICATION DATE. ADVERTISEMENTS IN THIS NEWSLETTER ARE PAID AND NOT NECESSARILY ENDORSEMENTS OF SERVICES OR PRODUCTS

MSPC NEWSLETTER 3 JULY, 1987 EQUIPMENT

Office Equipment: Sterilizer, centrifuge, incubator, lab equipment, exam tables, much more. Call 453-8892.

Antique exam tables. Call 453-8892.

Two complete treadmill systems with monitor and defibrillator. Call 453-8892.

PRACTICES AVAILABLE

OFFICE SPACE

Professional office space 3 blocks from Allenmore Medical Dental Building. Approx. 1,100 square feet remaining. Generous lease­ hold improvements $11 per square foot.

POSITIONS WANTED

Searching for that special physician? We have physicians looking for N.W. opportunities. Let us use our extensive data lease & national contacts to find the right person for you. Call: Western States Physician Services, Archelle Reynolds (206) 851- 6201 .

In-Patient Ps 7/~chiatrist. F~e for service. Hospital will handle billing and collection. Possibility of development of outpatient practice. Weekend psychiatrist 8:00 a.m. Saturday to 8:00 p.m. Sunday. Salary and benefits competitive. Contact John E. Kooiker, M.D. at Medical Director Psychiatry Unit, St. Peter Hospital, 413 North Lilly Road, Olympia, WA 98506, (206) 456- 7060 . GENERAL

Accounts Receivable up - or mixed up? Cash flow down? Call SE RE ’CO Associates to help you find out why. We are specialists in retrieval with management techniques for bookkeeping, office management, insurance claims, accounts receivable and payable. (206) 927-6540.

NEW ADDRESS AND PHONE NUMBER FOR DR. CARL A. PLONSKY: 1530 South Union, Suite #1, Tacoma, Washington 98405, 759-3333.

WAMPAC MSPC NEWSLETTER 4 JULY, 1987 BOARD ACTIONS JUNE 2, 1987 GOOD SAMARITAN HOSPITAL The Committee had not AS A PART OF THE CURRENT Present were: Drs_. Bowe reached a definitive GRIEVANCE. THOSE PRIOR (President) , P. Marsh, conclusion for the cause of COMPLAINTS WILL BE EVALU­ Schneider, Halstead, deaths. ATED IN COM JUNCTION WITH Hawkins, Duenhoelter, Wm. THE CURRENT GRIEVANCE IN Jackson, Whitney, Knight, Board members recommended AN EFFORT TO DELINEATE G. Anderson and Mrs. that a representative of REPEAT OFFENDERS. Beverly Graham: Drs. MAMC be asked to serve on DECISION RELATIVE TO THE Winemiller, A. White and the Committee and Dr. Al CURRENT GRIEVANCE BY Hautala;Dr. DeMaurice Allen, County Health NECESSITY WILL INCLUDE Moses, Guest; Mr. Jackman. Officer be asked to provide OUTCOMES FROM PRIOR A quorum was present. some assistance in securing GRIEVANCES." Dr. Hawkins the necessary information made a motion that "THE Finance Report... for the Task Force. RECOMMENDATION OF THE The fund balance as of GRIEVANCE COMMITTEE BE April 30 was $134,553 as Dr. Bowe and Board members ADOPTED BY THE BOARD OF compared to $121,004 at the thanked Dr. Moses and the TRUSTEES." same time in 1986. It was Committee for their reported that the Society efforts. The motion was seconded had achieved 95.4% of its and approved. projected paid memberships Auxiliary Report... for 1987 fiscal year. Mrs. Beverly Graham, EMS Committee... Auxiliary President It was reported that the Society membership was reported that Mrs. Sally Committee had approved a reported to be 614 which Larson had volunteered to Paramedic Recertification includes applicants and 16 again serve as co-chair of Process which would make who had yet to renew their the Tacoma Mall Health certain that paramedics 1987 membership. Fair. Sally, has been the are kept current at all driving force behind the times. Black Infant Mortality... Auxiliary/Society booth for Dr. DeMaurice Moses, the past three years. She Public Health/School Chairman, Black Infant has asked that a physician Health Committee... Mortality Task Force which co-chair the activities Three cases of measles in was appointed by Dr. Bowe this year. Dr. Bowe noted the Puyallup School to study reports that black that he will ask a physic­ District were reported. babies are dying at twice ian to serve with her. Dr. Torgenrud, Committee the rate of white babies in Chairman will write a Pierce County. It is Grievance Committee... letter to all school reported that this is true Dr. Hawkins, Chairman, district superintendents particularly in Tacoma, reported that the Grievance urging all school staff because many of their Committee passed a recom­ and students be immunized. mothers cannot get medical mendation to the Board of care during their pregnan­ Trustees that, "WHEN A Pierce County Medical cies. PHYSICIAN HAS A WRITTEN Library... GRIEVANCE BROUGHT AGAINST The Board reviewed the Dr. Moses reported that he HIM, THE EXECUTIVE DIRECTOR results of the membership had studied the death OF THE MEDICAL SOCIETY WILL survey and Dr. Bodily made certificates of the 18 ROUTINELY SCREEN THE a motion that, "THE BOARD black infants who had died GRIEVANCES FROM THE PRIOR OF TRUSTEES ACCEPT THE in 1985 and the Committee FIVE YEARS. PHYSICIANS RECOMMENDATION OF THE was continuing its study. FOUND TO HAVE THREE OR MORE EXECUTIVE COMMITTEE THAT GRIEVANCES IN A CONSECUTIVE ’THE LIBRARY COMMITTEE FIVE YEARS PERIOD WILL HAVE PROCEED WITH REORGANIZA­ THOSE GRIEVANCES INCLUDED TION OF THE LIBRARY TO

Continued on Next Page MSPC NEWSLETTER 5 JULY, 1987 Board of Trustees (Cont.)

IMPROVE ITS ORGANIZATIONAL sions, Dr. Bowe reported, STRUCTURE AND CLARIFY ITS centered on the current and LINES OF AUTHORITY.” ' The future EMS system in Pierce motion was seconded and County. Issues revolving unanimously approved. around the Medical Library and the College of Medical BOSSES NIGHT After further discussion a Education were also OCTOBER 27 motion was made by Dr. discussed. Hawkins, that "THE BOARD OF The Pierce County Chapter TRUSTEES ACCEPT THE Dr. Bowe expressed his and of Medical Assistants is RECOMMENDATION OF THE the other participants seeking physicians who EXECUTIVE COMMITTEE THAT satisfaction in the would like to share their ’THE MEDICAL SOCIETY IS meetings and felt much had entertainment talents at COMMITTED TO FUNDING OF THE been accomplished by the the Chapter’s Annual PIERCE COUNTY MEDICAL conversations with John ’Bosses Night’ on Tuesday, LIBRARY PROVIDED THAT THE Long and Barry Connoley and October 27. The event SOCIETY HAVE THE ABILITY TO staff. Meetings with all will be held at the CONTROL ITS LEVEL OF hospital administrators are Fircrest Golf Club. CONTRIBUTIONS TO THE planned. Bosses night is an annual SUPPORT OF THE LIBRARY.’" event sponsored by PCCMA, The motion was seconded and which allows medical unanimously approved. assistants an opportunity to thank their employers MBI Endorsement Policy... by attending an evening of entertainment, including The Board of Trustees TRANSLATORS/INTERPRETERS adopted a motion that,"THE cocktails, dinner and a MEDICAL SOCIETY OF PIERCE Have you had a need for a short program. COUNTY SUPPORTS ENDORSE­ translator or interpreter This year, entertainment MENTS BY MEMBERSHIP in your office practice BENEFITS, INC. OF PRODUCTS lately? Do you see will be provided by various local physicians, AND SERVICES WHICH ARE Cambodian, Vietnamese, in various capacities. If DIRECTLY RELATED TO THE Korean, or other ethnic PRACTICE OF MEDICINE.". groups that the services of you are a doctor, or if you know a doctor who has The motion was seconded and a translator are necessary unanimously approved. or would be helpful? talents to entertain others, please contact The motion was a result of Dr. George Tanbara, the Mary Ann Matherne at 627— discussion at the May Board Medical Society and several 9184 or Sue Asher at the meeting on the merits of organizations are trying to Medical Society office, MBI endorsing certain determine the need for 572-3709. products and services. interpreters in physician Also, if you would like to offices. Funds are being MSPC/Hospital Administrator find out more about Bosses sought to establish a Night for you and your Meetings... language bank where Dr. Bowe reported on his, physician employer call interpreters would be Sue or Mary Ann. It’s a Dr. Bill Jackson and Mr. available on call for Jackman’s meetings with Mr. great way to meet other service in a hospital or physicians and their staff John Long and Mr. Barry doctors office. Connoley, administrators of in addition to saying thank you to your em­ St. Joseph Hospital and If you have used an Multicare Medical Center ployer . interpreter within the past respectively. six months, please call the Medical Society office and The heart of the discus­ let us know.

MSPC NEWSLETTER 6 JULY, 1987 Crossroads Treatment Center Alcoholism A Program Designed to Provide Comprehensive Treatment for All Facets of Alcoholism Physician Directed THE DOCTORS’ EXCHANGE Family Treatment Included ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY Cost Effective Outpatient Program

Covered by many Health Insurance Plans

..Another First FOR INFORMATION CONTACT: Why settle for just Ted Berning, Administrator a phone number? 5909 Orchard St. West Tacoma, WA 98467 With the new Information (206)473-7474 Display Pager you can receive patient name, n a tu re of call CROSSROADS AND telephone No. TREATMENT INSTANTLY! CENTER Office: 272-4111 An Approved Washington Alcoholism Exchange: 272-3166 Treatment Facility Locally owned and operated.

908 Broadway, Suite 201 Tacoma, WA 98402

Membership Benefits, Inc. Medical Socicty of Pierce County

If yo u’re looking for qualified employees, or have other personnel issues you need help with

CALL

the Medical Society Office, Membership Benefits, Inc.

572-3709 Ask for Sharon

MSPC NEWSLETTER 8 JULY, 1987 The Medical Society of Pierce County welcomes the following who have made application for membership into the Society. As outlined in the Bylaws, any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Commit­ tee or Board of Trustees of the Society.

EDWARD L. BITSEFF, JR., M.D., Plastic Surgery. Born in Mt. Vernon, Washington, 2/17/48. Medical School, St. Louis University of Medicine, 1980; internship, Vanderbilt University, 7/80-67/81; residency, Vanderbilt University, 7/81-6/85; graduate training, Vanderbilt University, plastic surgery, 7/85-6/87. Washington State License, 1987. Dr. Bitseff is currently practicing at B-4008 Allenmore Medical Center, Tacoma.

NEWTON 0. DUNCAN, III, M.D., Otolaryngology. Born in Bryan, Texas, 8/3/52. Medical School, Baylor College of Medicine, 1978; internship, Letterman Army Medical Center, 7/78-7/79; residency, Baylor College of Medicine, General Surgery, 7/82-7/83 and Otolaryngology-Head & Neck Surgery, 7/83-7/86. Washington State License, 1987. Dr. Duncan is currently practicing with Group Health Cooperative.

SANDRA B. EDMONDS, M.D., Emergency Medicine. Born in Alabama, 8/18/46. Medical School, University of Virginia School of Medicine, 1972; internship, Virginia Mason Hospital, 6/72-6/73; residency, Virginia Mason Hospital, Surgery, 7/73-7/74. Washington State License, 1974. Dr. Edmonds is currently practicing at Good Samaritan Hospital Emergency Room.

DON C. FISHER, M.D., Occupational Medicine. Medical School, U niversity of Oklahoma Medical School, 1979; internship, Tulsa Medical College, 7/80-6/81; residency, Tulsa Medical College, 7/81-6/82 and University of Arizona, Family Practice and Occupational Medicine, 7/82-8/84. Washington State License, 1985. Dr. Fisher is currently practicing at 1718 South I Street, Tacoma.

LANCE E. MONROE, M.D., Addictive Diseases. Born in Paragould, Arkansas, 1/6/51. Medical School, University of Arkansas College of Medicine, 1976; residency, University of Arkansas, 7/76-6/77; graduate training, Naval Aviation Medical, 7/77- 9/77 and addictive diseases, 10/80-10/81. Washington State License, 1986. Dr. Monroe is currently practicing at Puget Sound Hospital.

WERNER H. PETERS, M.D., Anesthesiology. Born in Bochum, West Germany, 11/22/52. Medical School, Ludwig-Maximilian University of Munich, School of Medicine, 1978 and Loyala University Stritch School of Medicine, 1983; internship, The University of Chicago, 6/83-6/84; residency, University of California, Anes­ thesiology, 1/85-1/87; graduate training, University of California, Physiology, 11/78 11/80. Washington State License, 1987. Dr. Peters is currently practicing at Good Samaritan Hospital.

EDWARD A. PULLEN, M.D., Family Practice. Born in Seattle, Washington, 9/2/54. Medical School, Tufts University Medical School, 1980; internship, Madigan Army Medical Center, 7/80-6/81; residency, Madigan Army Medical Center, 6/81-6/83. Washington State License, 1987. Dr. Pullen is currently practicing at 3908 10th Street S.E., Puyallup.

JON L. RUCKLE, M.D.. Internal Medicine. Born in California, 4/29/51. Medical School, Loma Linda University School of Medicine, 11/30/80; internship, Loma Linda University Medical Center, Internal Medicine, 1/81-6/81; residency, Mayo Clinic, Internal Medicine, 7/81-6/84. Washington State License, 1987. Dr. Ruckle is currently practicing at 521 South K Street, Tacoma.

MSPC NEWSLETTER 7 JULY, 1987 1987 SALARY SURVEY Continued from Rage 1

MBI has just mailed the Some issues you might like 1987 salary survey to submit a Resolution on questionnaire to all could be: members. We hope all members will respond this EKO/W year in order to provide Medicare Reimbursement information helpful in Smoking hiring new staff and when Hospital Bylaws reviewing current staff AIDS for raises. Immunizations Fluoridation With your help in provid­ ing current staff salaries More details on the Annual M A R IN E VIEW we will have the survey Meeting will be forthcoming ready to send upon your This 6-bedroom, 4-bath brick home site from WSMA and MSEC. on over 112 acre in a very secluded setting request. It would be ap­ just south of the Narrows Bridge in preciated if you could Tacoma. The view is unsuipassedl complete the form and No power lines, trees or roof tops...just nature's beauty at its best! This 3,300 return it by July 15. ARE YOU AVAILABLE FOR LOCUM sq. ft. home also has an above-ground pool surrounded by decks, a 3-car TENENS? If sotf please detached garage, sunroom, rec. room and Thank you. contact the Society office, large, fenced yard with sprinkler system. The trees, shrubbery and flowers have 572-3667. been lovingly hand-picked over the years to add to the parkfike serenity of this home. DO YOU MAKE HOUSE CALLS? This offering is a rare opportunity. Priced at $225,000. For an exclusive showing, If so, please contact the call Spot Realty/Pentac, Inc., 858-8333 Of Society office at 572-3667. 383-2064. 383-5127. #40788.

PHYSICIANS Your Army Reserve Personnel Counsellor would like to talk to you about the following opportunities in the US Army Medical Department:

PART-TIME INCOME CONTINUING MEDICAL EDUCATION RETIREMENT POTENTIAL ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOR BY THE US ARMY RESERVE

Major Paul H. Lawhon, MSC 206-967-5046

Many groups TALK about building a better Amerlca- The Army Reserve WORKS at It.

MSPC NEWSLETTER 9 JULY, 1987 PeodatQ TRUCK IN STOCK SALE PRICED! PRICED! SALE INSTOCK TRUCK 2 KE DOWNT AO A TACOM ) N W TO N W O (D ET RK A M 925 SEE US TODAY...EASY TERMS! TODAY...EASY US SEE EVERY BRAND NEW CAR AND AND CAR NEW BRAND EVERY G N I P P O T

published every three to to three every is but published Directory, Annual four years in addition to to addition in years four the of is replacement a not Directory Pictorial annually. The is it as in December published be wili the Pocket Directory. Pocket the Directory- Pocket 1988 the 10 contact your Society Society your contact Pictorial Directory, please please Directory, Pictorial or comments regarding the regarding comments or have will Society , the Medical I B M of direction are welcomed. In addition, In welcomed. are suggestions and your is It publication administration. access to the photographs, photographs, the to access locally and under the the under and locally informa­ pertinent all other and photo’s profits, who Company aby California produced was Directory increased. being from dues h rft, etc.. profits, the If you have any suggestions suggestions any have you If retained and realized in MSPC, support Directory tion. Being produced produced Being tion. membership keep to efforts Membership of direction Society of Pierce County County Pierce of Society being produced and printed printed and produced being In 1984 The Pictorial Pictorial The 1984 In Inc Benefits, The Pictorial Directory is Directory Pictorial The subsidiary of the Medical Medical the of subsidiary locally this year under the under year this locally 572-3709. at please call Sue, right now, right Sue, call please so- 6 July until pictures picture in the Directory, Directory, the in picture having their pictures pictures their having own photos. We can take take can We photos. own by process our helped who scheduled is Distribution production. in is members, if you want to have your your have to want you if (MSPC). Profits from the from Profits (MSPC). their submitting or taken, members the all to Thanks for August, and production production and August, for Pictorial Directory, Directory, 1987 Pictorial the know, you As sgig smoothly. going is MSPC of pictures featuring 1987 PICTORIAL DIRECTORY PICTORIAL 1987 Continued UY 1987 JULY, (MBI), the AUXILIARY

MSPC Auxilians Assume State ^DIAPER RASH Leadership Positions IS NOT A WAY OF LIFE You can recommend professional Sharon Ann Lawson, Presi­ diaper service with confidence. dent of the MSPC’ Auxiliary • Laboratory Controlled. Each month 1985-86 has been elected a random sample of our diapers is President-Elect of the subjected to exhaustive studies in a Washington State Medical biochemical laboratory. Association Auxiliary, • Utm ost Convenience. Thanks to pick up and delivery service, our product Cindy Anderson was elected comes when you need it. RAKE COINS First Vice President. • Economical. All this service, all this MAKE MONEY and Alice Wilhyde will protection against diaper rash costs become News Editor of the far less than paper diapers only pennies more a day than home- l i v M W WSMAA MedAux. washed diapers.

CAUTION TO YOUR PATIENTS. II is illegal to Congratulations to Sharon dispose ol human excrement in garbage. During rhe post 10 yeors rare coins Ann, Cindy and Alice. Parents are doing this with paper/plastic hove ourp'jcecl oil, gold, sil/er, diapers. "Disposable" is a misnomer. diornonds, even real esrare, os o superior investment averaging over 20% annucil oppreciorion If you'd like more information ON TO CHICAGO FOR regarding building your own, persona AUXILIARY MEMBERS rare coin pan folio pleose give me a coll TACOMA WA TOLL FREE Here ar HRCI we guaranree whar Pierce County will be 383-BABY 1-800-562-BABY w e sell, and, w hether you're a new represented at the AMA Washington's Oldest, Most Trusted invesror or o seasoned professioriol we Auxiliary House of Dele­ Professional Diaper Service offer I Serving Our Second Generation I gates in Chicago, June 21- m INSTANT LIQUIDITY . . . Published bids rhar give PCGS cosh values 24 by Sharon Ann Lawson, ar any rime. WSMA Auxiliary President- SS LIFETIME GUARANTY o f c o in Elect and Alice Wilhyde, authenticity MedAux News Editor for m GUARANTEED REPURCHASE WSMAA. a g re e m e n ts H COMMISSION FREE counseling and soles seivice Alice will be one of eight @ UPDATED statem ents o f v a lu e presenters of successful Ron W illiams S PEACE OF MIND . . . Wirh guar­ county projects at the Realtor anteed PCGS coin grading annual program preview M A 15-day return privilege session. She will be R esid en tial Sales If you're a collector or on investor. . .HRCI presenting the Auxiliary wants to wort< with you to build a profitable 752-6696 Office portfolio. membership phone-a-thon 752-7069 Eves. project. # HERTZBERG W.H. Opie & Co. Realtors I S » Rare Coin Investments, Inc. The phone-a-thon was 5738 N. 26th I------responsible for the sharp Tacoma, WA 98407 Pleose send m e more rore coin informorion! increase in Auxiliary Name membership. Address

Phone

535 DOCK STREET. SUITE 204 TACOMA. WA 98402 (206) 627-2883 or 1-800-826-0039 A BONDED, LICENSED PROFESSIONAL

MSPC NEWSLETTER 11 JULY, 1987 TfcO* Physicians who prefer V * j ------medicine to paperwork.

We are looking for dedicated physi­ physicians who have joined the you are currently in a residency cians, physicians who want to be, not Army. Army Medicine is the perfect program such as Orthopedics, Neuro­ salesmen, accountants, and lawyers, setting for the dedicated physician. surgery, Urology, General Surgery, but physicians. For such physicians, Army Medicine provides wide-rang- or Anesthesiology, you may be eligi­ we offer a practice that is practically ing opportunities for the student, ble for the Army’s Sponsorship perfect. In almost no time you experi­ the resident, and the practicing P rogram . physician. ence a spectrum of cases some physi­ Army Medicine offers an attractive cians do not encounter in a lifetime. Army Medicine offers fully accred­ alternative to civilian practice. As an You work without worrying: whether ited residencies in virtually every Army Officer, you receive substan­ the patient can pay or you will be specialty. Army residents generally tial compensation, extensive annual paid, and you prescribe, not the least receive higher compensation and paid vacation, a remarkable retire­ care, nor the most defensive care, but greater responsibility than do their ment plan, and the freedom to prac­ the best care. civilian counterparts and score tice without endless insurance forms, If that is what you want, join the higher on specialty examinations. If malpractice premiums, and cash flow worries.

Army Medicine: CONTACT: AMEDD Personnel Counselor Ihe practice that’s Building 138, Room 116 Naval Support Activity (Sand Point) practicality aSS medicine. Seattle, W A 98115 (206) 526-3548/3307

B U L K RATE Medical Society of Pierce County U.S. POSTAGE 705 South Ninth Street, Suite 203 PAID Tacoma, WA 98405 TACOM A, WASH. P E R M IT NO. 605 J L

k k MSPC r

...._ i-7..' r"... rJ . / r7 ♦y4 publication of he Medical Society of Pierce County ♦

VOL. 2, NO. 5 705 South 9th, Suite 203 JULY, 1987 Tacoma, Washington 572-3667

REGISTERED TO VOTE?? HOW IS INITIATIVE 92 GOING If you don’t know where to INITIATIVE 92!! TO IMPACT YOUR PATIENTS, register, call the Medical YOUR PRACTICE, YOU, YOUR Society for the nearest Many critical issues will FUTURE? THINK ABOUT IT. place to register. If you face the voter stepping IT SHOULD BE WORTH THE have recently moved, just into the voting booth EFPORT TO GO AND REGISTER call the Election Depart­ November 3. One of them TO VOTE. will be INITIATIVE #92. ment, 591-7430 to have Initiative 92 would make it your records transferred a violation of the Consumer without having to re­ Protection Act for a register. 1987 WSMA ANNUAL MEETING medical doctor, osteopath, TACOMA SHERATON chiropractor, podiatrist, If you would like an SEPTEMBER 17-20 dentist, or optometrist to absentee ballot drop by or charge a Medicare-eligible write: Pierce County Plan on attending the 1987 patient in excess of Election Dept., 2401 South WSMA Annual Meeting to be Medicare’s "reasonable"- 35th St., Room 200, held in Tacoma, September charge for that service and Tacoma, WA 98409-7484. 17-20. The House of to fail to enroll, or con­ Delegates will convene at tinue, as a "participating" 1:30 p.m., Thursday, physician if treating INITIATIVE 92 September 17; with the Medicare-eligible patients. second session Saturday As stated in the above morning and afternoon, Seniors and disabled people article, on November 3, September 19; and final who have health insurance Washingtonians will vote on session Sunday morning, other than Medicare or want Initiative 92. September 21. to pay their own bills will not be able to see a WSMA Board of Trustees and All members are invited to physician who chooses not staff have prepared a attend and see Democracy in to participate in the packet of information on action. The Reference Medicare program under Initiative 92. You will be Committees will meet Friday Initiative 92. receiving it in early July. morning, September 18. Every vote will count. This is an opportunity to Will yours? If you are Please read it and become voice your opinion on not a registered voter, familiar with it. issues of importance to please make an effort to you. REGISTER 30 days prior to It is important that you If you would like to submit the election and at least start talking to your a Resolution for introduc­ 45 days prior to the patients on the impact of tion to the House of election if you will be this Initiative. This is a Delegates, please submit it voting on an absentee matter that should be a to the Medical Society ballot. federal issue rather than office prior to August 1. decided at the state level. Continued on Page 9 POSITIONS AVAILABLE

The Department of OB/GYN at Madigan Army Medical Center, Tacoma Washington has an immediate opening for the civilian position of Medical Officer (OB/GYN). Beginning salary is $55,225 per annum. Incumbent has responsibility for the examination, diagnosis and treatment of the full range of outpatients seen in the clinic. Performs minor office surgical procedures such as endometrial biopsies. Contact Kathleen Derry at Fort Lewis Civilian Person­ nel Office at (206) 967-2131 for further information and govern­ ment application forms.

WESTERN CLINIC, a large multispecialty clinic, is seeking physicians for the following positions: Family Practice at Port Clinic Facility - No night or weekends; no OB. General Internal Medicine - at Tacoma facility. Ob-Gyn - for both Tacoma and Gig Harbor facilities. Family Practice with OB - at Tacoma facility. All positions offer excellent starting salary, fringe benefits, and partnership potential. Contact William Brand, M.D., c/o the Western Clinic, 521 South "K" Street, Tacoma, WA 98405, 206-627- 9151 .

FAMILY PRACTICE - Excellent opportunity with Seattle’s leading provider of Family Practice. Positions available thru out greater Seattle. Current license BC/BE in family practice. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Avenue, #225, Seattle 98121, Debbie Phillips (206) 728-6888.

Full time position available for general practice M.D. in Gig Harbor Clinic, affiliated with G.H. physicians, needed by August 1987. Contact James Patterson, M.D. (206) 851-5121.

Physician Opening. Ambulatory care/minor emergency center. Full/Part time for FP/IM/EM trained, experienced physician located in Tacoma area. Flexible scheduling, pleasant setting, quality medicine. Contact David R. Kennel, M.D. at 5900 100th Street S.W., Suite 31, Tacoma, Washington 98499. Phone (206) 584-3123 or 582-2542.

Lakewood Hospital, South Puget Sound, recruiting for associates in: FAMILY PRACTICE and INTERNAL MEDICINE: is a 95-bed acute care surgical, medical and obstetrical hospital which has a new facility due for early ’88 completion. In addition, a very busy associate physician wishes to retire from his solo practice in INTERNAL MEDICINE. This practice, which was established and has run consistently since 1966, is for sale. BC/BE respond to Genie Latta, Physician Recruitment, Lakewood Hospital, 5702 100th St. S.W., Tacoma, WA 98499-0998, (206) 588-1711.

Family Practice Physician - 2 full time positions in growing community health center in King County. Competitive salary, malpractice paid by employer, deferred compensation plan avail­ able, health benefits. First position in Auburn/Federal Way area

MSPC NEWSLETTER 2 JULY, 1987 Continued from Page 2

and includes some low risk obstetrics. The second position is in Bellevue and currently includes no obstetrics. Provide com­ prehensive range of primary health services to patients of all ages, in patient care as required, nurse practitioner consulta­ tion, participate in a shared call system. Board eligible or certified in family practice. Send resume or VITA to SKCCHC 1025 South 3rd, Renton, Washington 98055 or call Jim Bauman or Molly Lanegraff at 206-226-7039.

Immediate Openings - Full time and part time positions and directorship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice, flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1- 800-554-4405 ask for Ginger.

______MILES TO GO!! St. Mary’s in Glacier If you would like to help Dr. Dave Pomeroy, Gig National Park. Dave reach the $10,000 Harbor Family physician, mark, you can send your tax who is biking his way He did say that Stevens deductible contribution to across America, called the Pass was a challenge, but his office at: 5122 Olympic Society office on June 10 the stiff head-wind from Dr. N.W., #203, Gig Harbor, to say all is going well. Coulee City to Spokane (100 WA 98335. He expressed his thanks to miles) was a bit tiring. all those who pledged The riders have been contributions enabling him averaging 80-85 miles per to make the trip. day.

The group of 190 riders The trip organization has who have pledged over 1.2 been superb, Dave reports, million dollars to the with excellent back up American Lung Association support for the riders. were into their second week of riding. They Dave has been one of the expect to arrive in more successful fund Atlantic City, New Jersey raisers among the riders. on July 16. He says he is just $1,000 short of reaching $10,000 Dave reported that the and 5-rants all of his weather has been beautiful colleagues and supporters and he was preparing to to know that he is still WAMPAC pitch tent that evening at accepting pledges.

Continued

ADVERTISING AND NEWSLETTER COPY MUST ARRIVE IN THE SOCIETY OFFICE BY THE 15TH DAY OF THE MONTH PRECEDING THE PUBLICATION DATE. ADVERTISEMENTS IN THIS NEWSLETTER ARE PAID AND NOT NECESSARILY ENDORSEMENTS OF SERVICES OR PRODUCTS

MSPC NEWSLETTER 3 JULY, 1987 EQUIPMENT

Office Equipment: Sterilizer, centrifuge, incubator, lab equipment, exam tables, much more. Call 453-8892.

Antique exam tables. Call 453-8892.

Two complete treadmill systems with monitor and defibrillator. Call 453-8892.

PRACTICES AVAILABLE

OFFICE SPACE

Professional office space 3 blocks from Allenmore Medical Dental Building. Approx. 1,100 square feet remaining. Generous lease­ hold improvements $11 per square foot.

POSITIONS WANTED

Searching for that special physician? We have physicians looking for N.W. opportunities. Let us use our extensive data lease & national contacts to find the right person for you. Call: Western States Physician Services, Archelle Reynolds (206) 851- 6201.

In-Patient Psychiatrist. F-^e fo r service. Hospital will handle billing and collection. Possibility of development of outpatient practice. Weekend psychiatrist 8:00 a.m. Saturday to 8:00 p.m. Sunday. Salary and benefits competitive. Contact John E. Kooiker, M.D. at Medical Director Psychiatry Unit, St. Peter Hospital, 413 North Lilly Road, Olympia, WA 98506, (206) 456- 7060 . GENERAL

Accounts Receivable up - or mixed up? Cash flow down? Call SE RE’CO Associates to help you find out why. We are specialists in retrieval with management techniques for bookkeeping, office management, insurance claims, accounts receivable and payable. (206) 927-6540.

NEW ADDRESS AND PHONE NUMBER FOR DR. CARL A. PLONSKY: 1530 South Union, Suite #1, Tacoma, Washington 98405, 759-3333.

WAMPAC MSPC NEWSLETTER 4 JULY, 1987 BOARD ACTIONS JUNE 2. 1987 GOOD SAMARITAN HOSPTTAT, The Committee had not AS A PART OF THE CURRENT Present were: Drs.. Bowe reached a definitive GRIEVANCE. THOSE PRIOR (President), P. Marsh, conclusion for the cause of COMPLAINTS WILL BE EVALU­ Schneider, Halstead, deaths. ATED IN CONJUNCTION WITH Hawkins, Duenhoelter, Wm. THE CURRENT GRIEVANCE IN Jackson, Whitney, Knight, Board members recommended AN EFFORT TO DELINEATE G. Anderson and Mrs. that a representative of REPEAT OFFENDERS. Beverly Graham: Drs. MAMC be asked to serve on DECISION RELATIVE TO THE Winemiller, A. White and the Committee and Dr. A1 CURRENT GRIEVANCE BY Hautala;Dr. DeMaurice Allen, County Health NECESSITY WILL INCLUDE Moses, Guest; Mr. Jackman. Officer be asked to provide OUTCOMES FROM PRIOR A quorum was present. some assistance in securing GRIEVANCES." Dr. Hawkins the necessary information made a motion that "THE Finance Report... for the Task Force. RECOMMENDATION OF THE The fund balance as of GRIEVANCE COMMITTEE BE April 30 was $134,553 as Dr. Bowe and Board members ADOPTED BY THE BOARD OF compared to $121,004 at the thanked Dr. Moses and the TRUSTEES." same time in 1986. It was Committee for their reported that the Society efforts. The motion was seconded had achieved 95.4% of its and approved. projected paid memberships Auxiliary Report... for 1987 fiscal year. Mrs. Beverly Graham, EMS Committee... Auxiliary President It was reported that the Society membership was reported that Mrs. Sally Committee had approved a reported to be 614 which Larson had volunteered to Paramedic Recertification includes applicants and 16 again serve as co-chair of Process which would make who had yet to renew their the Tacoma Mall Health certain that paramedics 1987 membership. Fair. Sally, has been the are kept current at all driving force behind the times. Black Infant Mortality. .. Auxiliary/Society booth for Dr. DeMaurice Moses, the past three years. She Public Health/School Chairman, Black Infant has asked that a physician Health Committee... Mortality Task Force which co-chair the activities Three cases of measles in was appointed by Dr. Bowe this year. Dr. Bowe noted the Puyallup School to study reports that black that he will ask a physic­ District were reported. babies are dying at twice ian to serve with her. Dr. Torgenrud, Committee the rate of white babies in Chairman will write a Pierce County. It is Grievance Committee... letter to all school reported that this is true Dr. Hawkins, Chairman, district superintendents particularly in Tacoma, reported that the Grievance urging all school staff because many of their Committee passed a recom­ and students be immunized. mothers cannot get medical mendation to the Board of care during their pregnan­ Trustees that, "WHEN A Pierce County Medical cies. PHYSICIAN HAS A WRITTEN Library. •• GRIEVANCE BROUGHT AGAINST The Board reviewed the Dr. Moses reported that he HIM, THE EXECUTIVE DIRECTOR results of the membership had studied the death OF THE MEDICAL SOCIETY WILL survey and Dr. Bodily made certificates of the 18 ROUTINELY SCREEN THE a motion that, "THE BOARD black infants who had died GRIEVANCES FROM THE PRIOR OF TRUSTEES ACCEPT THE in 1985 and the Committee FIVE YEARS. PHYSICIANS RECOMMENDATION OF THE was continuing its study. FOUND TO HAVE THREE OR MORE EXECUTIVE COMMITTEE THAT GRIEVANCES IN A CONSECUTIVE ’THE LIBRARY COMMITTEE FIVE YEARS PERIOD WILL HAVE PROCEED WITH REORGANIZA­ THOSE GRIEVANCES INCLUDED TION OF THE LIBRARY TO

Continued on Next Page MSPC NEWSLETTER 5 JULY, 198 7 Board of Trustees (Cont.)

IMPROVE ITS ORGANIZATIONAL sions, Dr. Bowe reported, STRUCTURE AND CLARIFY ITS centered on the current and LINES OF AUTHORITY.’" The future EMS system in Pierce motion was seconded and County. Issues revolving unanimously approved. around the Medical Library and the College of Medical BOSSES NIGHT After further discussion a Education were also OCTOBER 27 motion was made by Dr. discussed. Hawkins, that "THE BOARD OF The Pierce County Chapter TRUSTEES ACCEPT THE Dr. Bowe expressed his and of Medical Assistants is RECOMMENDATION OF THE the other participants seeking physicians who EXECUTIVE COMMITTEE THAT satisfaction in the would like to share their ’THE MEDICAL SOCIETY IS meetings and felt much had entertainment talents at COMMITTED TO FUNDING OF THE been accomplished by the the Chapter’s Annual PIERCE COUNTY MEDICAL conversations with John ’Bosses Night’ on Tuesday, LIBRARY PROVIDED THAT THE Long and Barry Connolev and October 27. The event SOCIETY HAVE THE ABILITY TO staff. Meetings with all will be held at the CONTROL ITS LEVEL OF hospital administrators are Fircrest Golf Club. CONTRIBUTIONS TO THE planned. Bosses night is an annual SUPPORT OF THE LIBRARY. event sponsored by PCCMA, The motion was seconded and which allows medical unanimously approved. assistants an opportunity to thank their employers MBI Endorsement Policy.,. by attending an evening of entertainment, including The Board of Trustees TRANSLATORS/INTERPRETERS adopted a motion that,"THE cocktails, dinner and a MEDICAL SOCIETY OF PIERCE Have you had a need for a short program. COUNTY SUPPORTS ENDORSE­ translator or interpreter This year, entertainment MENTS BY MEMBERSHIP in your office practice will be provided by BENEFITS, INC. OF PRODUCTS lately? Do you see various local physicians, AND SERVICES WHICH AHE Cambodian, Vietnamese, in various capacities. If DIRECTLY RELATED TO THE Korean, or other ethnic PRACTICE OF MEDICINE.". groups that the services of you are a doctor, or if you know a doctor has The motion was seconded and a translator are necessary who unanimously approved. or would be helpful? talents to entertain others, please contact The motion was a result of Dr. George Tanbara, the Mary Ann Matherne at 627- discussion at the May Board Medical Society and several 9184 or Sue Asher at the meeting on the merits of organizations are trying to Medical Society office, MBI endorsing certain determine the need for 572-3709. products and services. interpreters in physician Also, if you would like to offices. Funds are being MSPC/Hospital Administrator f ind out more about Bosses sought to establish a Night for you and your Meetings... language bank where Dr. Bowe reported on his, physician employer call interpreters would be Sue or Mary Ann. It’s a Dr. Bill Jackson and Mr. available on call for Jackman's meetings with Mr. great way to meet other service in a hospital or physicians and their staff John Long and Mr. Barry doctors office. Connolev, administrators of in addition to saying thank you to your em­ St, Joseph Hospital and If you have used an Multicare Medical Center ployer . interpreter within the past respectively. six months, please call the Medical Society office and The heart of the discus­ let us know.

MSPC NEWSLETTER 6 JULY, 1987 The Medical Society of Pierce County welcomes the following who have made application for membership into the Society. As outlined in the Bylaws, any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Commit­ tee or Board of Trustees of the Society.

EDWARD L. BITSEFF, JR., M.D., Plastic Surgery. Born in Mt. Vernon, Washington, 2/17/48. Medical School, St. Louis University of Medicine, 1980; internship, Vanderbilt University, 7/80-67/81; residency, Vanderbilt University, 7/81-6/85; graduate training, Vanderbilt University, plastic surgery, 7/85-6/87. Washington State License, 1987. Dr. Bitseff is currently practicing at B-4008 Allenmore Medical Center, Tacoma.

NEWTON O. DUNCAN, III, M.D., Otolaryngology. Born in Bryan, Texas, 8/3/52. Medical School, Baylor College of Medicine, 1978; internship, Letterman Army Medical Center, 7/78-7/79; residency, Baylor College of Medicine, General Surgery, 7/82-7/83 and Otolaryngology-Head & Neck Surgery, 7/83-7/86. Washington State License, 1987. Dr. Duncan is currently practicing with Group Health Cooperative.

SANDRA B. EDMONDS, M.D., Emergency Medicine. Born in Alabama, 8/18/46. Medical School, University of Virginia School of Medicine, 1972; internship, Virginia Mason Hospital, 6/72-6/73; residency, Virginia Mason Hospital, Surgery, 7/73-7/74. Washington State License, 1974. Dr. Edmonds is currently practicing at Good Samaritan Hospital Emergency Room.

DON C. FISHER, M.D., Occupational Medicine. Medical School, U niversity of Oklahoma Medical School, 1979; internship, Tulsa Medical College, 7/80-6/81; residency, Tulsa Medical College, 7/81-6/82 and University of Arizona, Family Practice and Occupational Medicine, 7/82-8/84. Washington State License, 1985. Dr. Fisher is currently practicing at 1718 South I Street, Tacoma.

LANCE E. MONROE, M.D., Addictive Diseases. Born in Paragould, Arkansas, 1/6/51. Medical School, University of Arkansas College of Medicine, 1976; residency, University of Arkansas, 7/76-6/77; graduate training, Naval Aviation Medical, 7/77- 9/77 and addictive diseases, 10/80-10/81. Washington State License, 1986. Dr. Monroe is currently practicing at Puget Sound Hospital.

WERNER H. PETERS, M.D., Anesthesiology. Born in Bochum, West Germany, 11/22/52. Medical School, Ludwig-Maximilian University of Munich, School of Medicine, 1978 and Loyala University Stritch School of Medicine, 1983; internship, The University of Chicago, 6/83-6/84; residency, University of California, Anes­ thesiology, 1/85-1/87; graduate training, University of California, Physiology, 11/78 11/80. Washington State License, 1987. Dr. Peters is currently practicing at Good Samaritan Hospital.

EDWARD A. PULLEN, M.D., Family Practice. Born in Seattle, Washington, 9/2/54. Medical School, Tufts University Medical School, 1980; internship, Madigan Army Medical Center, 7/80-6/81; residency, Madigan Army Medical Center, 6/81-6/83. Washington State License, 1987. Dr. Pullen is currently practicing at 3908 10th Street S.E., Puyallup.

JON L. RUCKLE, M.D.. Internal Medicine. Born in California, 4/29/51. Medical School, Loma Linda U niversity School of Medicine, 11/30/80; internship, Loma Linda University Medical Center, Internal Medicine, 1/81-6/81; residency, Mayo Clinic, Internal Medicine, 7/81-6/84. Washington State License, 1987. Dr. Ruckle is currently practicing at 521 South K Street, Tacoma.

MSPC NEWSLETTER 7 JULY, 1987 Crossroads Treatment Center Alcoholism A Program Designed to Provide Comprehensive Treatment for All Facets of Alcoholism

Physician Directed THE DOCTORS’ EXCHANGE Family Treatment Included ENDORSED B Y THE MEDICAL SOCIETY OF PIERCE COUNTY Cost Effective Outpatient Program

Covered by many Health Insurance Plans

...Another First FOR INFORMATION CONTACT: Why settle for Just Ted Berning, Administrator a phone number? 5909 Orchard St. West Tacoma, WA 98467 W ith the new Information (206)473-7474 D isplay Pager you can receive p a tie n t name, nature of call CROSSROADS AND telep h o n e No. TREATMENT INSTANTLY! CENTER Office: 272-4111 An Approved Washington Alcoholism Exchange: 272-3166 Treatment Facility Locally owned and operated.

908 Broadway. Suite 201 Tacoma, WA 98402 Membership Benefits, Inc. Medical Society of Pierce County

If y o u ’re looking for qualified euployees, or have other personnel issues you need help with

CALL

the Medical Society Office, Membership Benefits, Inc.

572-3709 Ask for Sharon

MSPC NEWSLETTER 8 JULY, 1987 1987 SALARY SURVEY Continued from Page 1

MBI has just mailed the Some issues you might like 1987 salary survey to suhmit a Resolution on 1 questionnaire to all could be: members. We hope all members will respond this PRO/W year in order to provide Medicare Reimbursement information helpful in Smoking hiring new staff and when Hospital Bylaws reviewing current staff AIDS for raises. Immunizations Fluoridation With your help in provid­ MAGNIFICENT ing current staff salaries More details on the Annual MARINE VIEW we will have the survey Meeting will be forthcoming ready to send upon your This 6-badroom, 4-bath brick home site from WSMA and MSPC. on over 1/2 acre in a very secluded setting request. It would be ap­ just south of the Narrows Bridge in preciated if you could Tacoma. The view is unsurpassed! complete the form and No power lines, trees or roof tops...just nature's beauty at its bestl This 3,300 return it by July 15. ARE YOU AVAILABLE FOR LOCUM sq. ft. home also has an above-ground pool surrounded by decks, a 3-car TENENS? If so,, please detached garage, sunroom, rec. room and Thank you. contact the Society office, large, fenced yard with sprinkler system. The trees, shrubbery and flowers have 572-3667. been lovingly hand-picked over the years to add to the parklike serenity of this home. DO YOU MAKE HOUSE CALLS? This offering is a rare opportunity. Priced at $225,000. For an exclusive showing, If so, please contact the call Spot Realty/Pentac, Inc., 8 58-6333o( Society office at 572-3667. 383-2064. Or, call John Mosich, eves. 383-5127. #40788.

PHYSICIANS

Your Armp Reserve Personnel Counselor would like to talk to you about the following opportunities m the VS Armp Medical Department:

PART-TIME INCOME CONTINUING MEDICAL EDUCATION RETIREMENT POTENTIAL ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOB BY THE US AKMY RESEffiVE

Major Paul H. Lawhon, MSC

Many groups TALK about building a batter America- The Army Reserve WORKS at It.

MSPC NEWSLETTER 9 JULY, 1987 Prodata TRUCKIN STOCK SALEPRICED! 5MAR T( AOMA M TACO ) N W O T N W O (D ET RK A M 25 9 SEEUSTODAY-EASYTERMS! EVERY BRANDNEW CAR AND I TOPPING V) £ VOLVO-NISSAN REDUCTION SALE! INVENTORY MSPC NEWSLETTER NEWSLETTER MSPC Yo lt wno n ntow ow D ality u Q r ou "Y 572-3333 Im po rt Dealer" rt po Im County City QcSg. Pacific Avo. Pacific j

nulDrcoy bt is but Directory, Annual published every three to to three every published is Directory Pictorial annually. The is it as in December published be wili not a replacement of the the of replacement a not four years in addition to to addition in years four Directory- Pocket 1988 the the Pocket Directory. Pocket the 10 Directory was produced by aby produced was Directory printed and produced being Medical Society will have have will Society Medical all and photo’s profits, who Company California increased. being from dues in MSPC, support Directory County Pierce of Society the (MBI), Inc Benefits, Membership of direction is Directory Pictorial The scheduled is production. Distribution in is members, direction of MBI, the the MBI, of direction 572-3709. now, right at Sue, call please Directory, the in picture so- 6 July until pictures pictures their by having process our helped members who the all to Thanks realized and retained retained and realized membership keep to efforts contact your Society Society your please contact Directory, Pictorial photographs, the to access informa­ pertinent other Medical the of subsidiary the under year this locally take can We photos. own Directory, 1987 Pictorial the know, you As or comments regarding the regarding comments or the under and locally your have to want you if their submitting or taken, publication and suggestions suggestions and your is It publication administration. etc.. profits, the Pictorial The 1984 In are welcomed. In addition, In welcomed. are produced Being tion. production and August, for MSPC of pictures featuring s on smoothly. going is If you have any suggestions suggestions any have you If (MSPC). Profits from the the from Profits (MSPC). 1987 PICTORIAL DIRECTORY PICTORIAL 1987 i d e u tin n o C UY 1987 JULY, AUXILIARY

MSPC Auxilians Assume State DIAPER RASH 1 Leadership Positions IS NOT A WAY OF LIFE You can recommend professional Sharon Ann Lawson, Presi­ diaper service with confidence. dent of the MSPC Auxiliary • Laboratory Controlled. Each m onth 1985-86 has been elected a random sample of o ur diapers is President-Elect of the subjected to exhaustive studies in a Washington State Medical biochemical laboratory. Association Auxiliary. • Utmost Convenience. Thanks to pick up and delivery service, our product Cindy Anderson was elected comes when you need it. First Vice President, • Economical. All this service, all this and Alice Wilhyde will protection against diaper rash costs become News Editor of the far less than paper diapers - only pennies more a day than home- WSMAA MedAux. washed diapers. CAUTION TO YOUR PATIENTS. It is illegal to Congratulations to Sharon dispose ol human excrement in garbage. Di irrnq the pusr 10 years tore coins Ann, Cindy and Alice. Parents are doing this with paper/plastic have outpaced oil. gold silver, diapers. "Disposable" is a misnomer. diam onds. ■ r. s esraie os o superior investment . averaging over 20% annual appreciation If you’d like more informorion OH TO CHICAGO FOR legording building your own, personal AUXILIARY MEMBERS rare com portfolio please give me a TACOMA WATOLL FREE Here or Hf'-.CI we guarantee whot Pierce County will be 383-BABY 1-800-562-BABY w e sell, and, w hether you're a new represented at the AMA Washington's Oldest, Most Trusted invesior or o seasoned professional v/e Auxiliary House of Dele­ Professional Diaper Service Lire:' I Serving Our Second Generation gates in Chicago, June 21- §3 INSTANT LIQUIDITY . . . Published bids rhar give PCGS cash values 24 by Sharon Ann Lawson, or any rime. WSMA Auxiliary President- B LIFETIME GUARANTY o f c o in Elect and Alice Wilhyde, aurhenficiry MedAux News Editor for B GUARANTEED REPURCHASE WSMAA. agreements ®! COMMISSION FREE counseling and soles seivice Alice will be one of eight 18 UPDATED statem ents o f v a lu e presenters of successful R on W illiam s m PEACE OF MIND . . . With guar­ county projects at the Realtor anteed PCGS coin grading annual program preview B A 15-day return privilege session. She will be R esid en tial S ales If you're o collector or on investor. . .HRCI presenting the Auxiliary wonts to work with you to build a profitable 752-6696 Office portfolio. membership phone-a-thon 752-7069 Eves. project. HERTZBERG W.H. Opie & Co. Realtors Rare Coin Investments, Inc. The phone-a-thon was 5738 N. 26th responsible for the sharp Tacoma, WA 98407 Pleose send me more roie com informotion!^ increase in Auxiliary Nam e membership. Address

Phone

535 DOCK STREET. SUITE 204 TACOMA. WA 98402 (206) 627-2883 or 1 ■800-826-0039 A BONDED, LICENSED PROFESSIONAL

MSPC NEWSLETTER 11 JULY, 1987 *. Physicians who prefer ------' medicine to paperwork.

We are looking for dedicated physi­ physicians who have joined the you are currently in a residency cians, physicians who want to be, not Army. Army Medicine is the perfect program such as Orthopedics, Neuro­ salesmen, accountants, and lawyers, setting for the dedicated physician. surgery, Urology, General Surgery, but physicians. For such physicians, Army Medicine provides wide-rang- or Anesthesiology, you may be eligi­ we offer a practice that is practically ing opportunities for the student, ble for the Army’s Sponsorship perfect. In almost no time you experi­ the resident, and the practicing Program . ence a spectrum of cases some physi­ physician. Army Medicine offers an attractive cians do not encounter in a lifetime. Army Medicine offers fully accred­ alternative to civilian practice. As an You work without worrying whether ited residencies in virtually every Army Officer, you receive substan­ the patient can pay or you will be specially. Army residents generally tial compensation, extensive annual paid, and you prescribe, not the least receive higher compensation and paid vacation, a remarkable retire­ care, nor the most defensive care, but greater responsibility than do their ment plan, and the freedom to prac­ the best care. civilian counterparts and score tice without endless insurance forms, If that is what you want, join the higher on specialty examinations. If malpractice premiums, and cash flow worries.

Army Medicine: CONTACT: AMEDD Personnel Counselor The practice that’s Building 138, Room 116 Naval Support Activity (Sand Point) practically all medicine. Seattle, WA 98115 (206) 526-3548/3307

B U L K RATE Medical Society of Pierce County U.S. POSTAGE 705 South Ninth Street, Suite 203 PAID Tacoma, WA 98405 TACOM A, WASH. PERMIT NO. 60S MEDICAL SOCIETY OF PIERCE COUNTY August 1987

Washington State Medical Association

The Future of Medicine 1987 See Pages 4, 20 & 21 Annual Meeting News on "Initiative 92" See Page 5

AIDS Update September 17-20 See Pages 14 & 15

Tacoma Sheraton

Tacoma, Washington If you’d like your older patients to be a little more comfortable, just prescribe this number 572-2323

That’s the number for a new concept • The Cigma Travel Club. • Private rooms at the semi-private rate in caring about older Americans. It’s called • Assistance in preparing Medicare or other (when available). Humana Seniors Association, and it’s a locally insurance forms. • Free overnight stay in the patient’s room directed, non-profit organization aimed at mak­ • Transportation to donors' offices or hospital. by a spouse o r family m em ber. ing life just a little easier for Tacoma’s senior • Subscription to a special newsletter edited • Special registration by telephone. citizens. Membership in Humana Seniors for seniors. • Expedited courtesy check-out procedures. Association costs jusl pennies a dav. Vet il pro­ • In-patient and home visitations, where • One m onth’s free use of the Personal vides a whole range ol services aimed at mak­ required or requested. Security' Communications Device, after ing life more pleasant and si-run- lot' membei's, Members are also eligible lor discount discharge. Mitnibrrship allows a< i I n : mail-order drug's and a reduced monthly When you check your older patients r- i -jj-’j.i1 ■. r; ■: - rid\ ism lo j i.u ik i [iniiscl- lease lor a Personal Security Communications into Hum ana’s special Geriatrics Unit, you . .. ■ (i'll as i on- Devic e—a system that provides a remote con­ knowr they’re being admitted to one of the trol phone link lor emergency use. Pacific Northwest’s leaders in the field. i ly-rjiir patient requires hospitalization... Now we’re beefing up that leadership with I lumana I lospilal-Tacoma provides the Hum ana Seniors Association. We invite you "■i1, ii’ 'il;; services and am enities for m em bers: —and y o u r p atien ts—to becom e part of it. : Hospital-Tacoma ! i-mii m bring in need inlothe hands of a docior.sxl ami 1 1 nion Streets Tacoma,WA 98405 The Official Publication o f the Medical Society o f Pierce County

MSPC Officers: Richard G. Bowe, President; William B. Jackson, President-elect; Kenton C. Bodily, Vice President; Robert B. Whitney, 4 President's Page Secretary-Treasurer; Richard Hawkins, Past "Mamas Don't Let Your Babies Grow Up To Be Doctors" President. 5 Newsbriefs MSPC Trustees: Michael L. Halstead, Peter K. Initiative 92 Marsh, Paul D. Schneider, Johann H. Duenh'oelter 1987; Gerald W. Anderson, Ronald Sound -to-Narrows Race W. Knight, Eileen R. Toth, 1988, Beverly Committee on Aids discusses issues confronting medical community Graham. AMA News

Executive Director: Douglas R. Jackman 10 InMemoriam Dr. Robert Gordon Bond Board and Committee Chairman: AIDS: Alan Tice; Bylaws Stanley Tuell; Budget/Finance: Robert B. Whitney; College of 11 The Do's and Don'tsof Being a Medical Witness Medical Education, Peter K. Marsh; From LACMA Physician Credentials: Richard E. Waltman; Emergency Medical Standards: James K. Fulcher 12 "Death in a Family" Ethics/Standards of Practice: Ronald G. Commentary by Lawrence R. Ricci, MD: From Journal of the American Taylor; Grievance: Richard Hawkins; Interprofessional: Robert J. Martin; Medical Association Legislative: Gregory A. Popich; Library: Gilbert G. Johnston; Medical Education: David 13 Editorial Commentary I Brown; Medical-Legal: Marcel Malden; On Memories, by Richard Hawkins, MD Membership Benefits, Inc., Donald W. Shrewsbury; Personal Problems of Physicians, Pat Donley; Program: Kenton C. Bodily; Public 14 Aids Update Health/School Health, Terry Torgenrud; UHI HIV Antibody Testing, by Steve Heilig, MPH, Staff Associate Quality Assurance: David Sparling; Committee San Francisco Medicine on Aging: David R. Munoz. 16 "A Week If We Treat It - Seven Days If We Don’t ( The Bulletin is published quarterly, February, By Lee A Norman, MD. King County Medical Society Bulletin May, August and November, by the Medical Society of Pierce County, 705 South 9th, Suite 203, Tacoma, WA 98405. Telephone (206) 572- 18 Making the Right Decision 3666. Bulk Rate U.S. Postage paid at Tacoma, By Sharon Bain, Membership Benefits Inc. Washington. The Bulletinis published in the interest of medicine and allied professions. 19 Reporting Preventable Diseases The opinions herein are those of the individual Procedures and Guidelines from Pierce County Health Department contributors and do not necessarily reflect the official position of the Medical Society. Acceptance of advertising in no way 20 Building a Future Together constitutes professional approval or Proud of medicine's past and future: A "winning" essay by retired endorsement of products or services physician Dr. Herbert R. Glodt, Pittsfield, Mass. advertised. The Bulletin and the Medical Society of Pierce County reserve the right to reject any advertising. 22 AMA Survey of Physicians Opinion on Health Care Issues

Editor: David S. Hopkins 23 Membership

Managing Editor: Douglas R. Jackman 24 Auxiliary News Editorial Committee: David S. Hopkins Auxiliary in a Different Dimension: Report from Chicago (Chairman), Stanley W. Tuell, W. Ben Blackett, by Alice Wilhyde Richard Hawkins President's Message President's Committees (see page 26 and 27) Production: Mary K. Tipton 28 General Membership Meeting Announcement ^ Advertising: Sue Asher, Membership Benefits, and Registration Form Inc., Medical Society of Pierce County 572-3709. Beverly Foley, 2607 Bridgeport Way West, 29 Medical School Forms Suite 2C, Tacoma, (206) 564-3839

Subscriptions: $20 per year, $2 per issue. Make all checks payable to Pierce County Medical Society.

1987 August The Bulletin 3 President's Page Mamas Don't Let Your Babies Grow Up To Be Doctors

No it's not #1 on the country being controlled more by the third entice future physicians. western charts this week, and no it's party carrier (who pays the bill and Suggestions included changes in not sung by William Nelson, MD or W. calls the shots), malpractice premiums admission policies, including better Jennings, MD. What it is, though, is are out of sight because of a litigious communication between medical the often heard admonition from society, etc. etc, etc. It’s no wonder schools and liberal arts colleges, todays docs to whoever will listen, we’re frustrated and anxious. admitting some students earlier, and usually other docs. We've all heard Regretfully, discouragement giving more consideration to some of our colleagues tell each by physicians is only one of the many interviews and essay writing ability other orfellow golfers, drinking reasons why todays bright students rather than the traditional grade point buddies or dinner companions that are abandoning medicine and turning and MCAT scores. Curriculum the life of a doctorisnt fortheirown to other rewarding and lucrative changes were also recommended. kids and shouldn’t be for theirs careers. A recent survey of people Suggestions included more time to either. What has happened to who scored 9 or better on the Medical study, think, reflect and analyze as engender this about-face in thinking College Admissions Test (MCAT) but opposed to traditional rote from that idealistic drive that motivated who didn’t apply to medical school memorization, and taking a each of us to spend the first 30 years was made by the Association of reductionist view of education, of our lives in training, go deeply in American Medical Colleges (AAMC). moving away from ponderous details debt and work so hard to get where Of the 534 respondents (1/3 of those and toward general principles. we are now? surveyed), most stated that they Despite the many negative According to Dr. Roy would apply in a later year, but over aspects of the practice of medicine Schwartz, AMA assistant executive 20% stated that they had changed and the problems being faced in vice president for medical education career plans. Reasons given were: medical education, I for one still feel it and science, competent physicians medical school cost to much (37%), is the best profession available for a are troubled, puzzled, frustrated, medical education training programs bright, well-motivated, conscientious depressed and even outraged at were too long (26%), they were and idealistic individual. I haven't tried what is going on in the profession. discouraged by MD’s with whom they to discourage my three kids (all in their He describes a national epidemic of had spoken (29%), changes in the early 20's ) from becoming physicians, anxiety among physicians reflecting health care system were impairing although so far the closest I've come more than the self-pity outlined in a physician's independence (34%). is one dental hygienist and one recent Newsweek article. Only 8% said a lessened respect for ophthalmic assistant. Otis Bowen, Although the reasons for this physicians by the public was a factor. MD, secretary of the Department of are numerous, we hear the same few Between 1978 and 1986 the number Health and Human Services said, "no mentioned time and time again: our of applicants to U.S. medical schools other profession that I know of offers leadership is weak (the AMA dropped 14.5% (from 36,636 to 31, young people the best of both represents less than half of the U.S. 323) while the segment of population worlds; the chance to do well for physicians), we are faced with a encompassing most medical school themselves while doing good for growing body of important information applicants (age 18-24) only others." Let’s not forget what and sophisticated technology but are decreased 3.4% The applicant to motivated us to become docs and forced to contain costs using them, acceptance ratio dropped from 2.2 to hang out our shingles here in peer review is demanded but 1 in 1978 to 1.8 to 1 in 1986. Pierce County. Encouragement participants fear lawsuits and FTC Those involved in medical given to someone in school today charges of antitrust over their education are rightfully concerned. A will ensure the best in medical decisions, the congeniality among recent conference jointly sponsored care here physicians is being threatened by a by the AMA, American Hospital tomorrow.D competitive force as the | Association and the Association of buccaneers o ', medicine seek to j American Medical Colleges focused Richard G. Bowe control a greater share of the health I on the recent changes in medicine ooliar, physician-patient relationship is and the strategies necessary to

4 The Bulletin August 1987 "No on 92" bypass the Medicare system altogether. When it upheld that law WSMA Annual Campaign last year, the district court in Massachusetts conceded that there Meeting: underway! was significant risk that mandatory All members have received their assignment would decrease access Sept. 17-20 WSMA "No On 92" campaign kit with to care for seniors, especially in Tacoma Sheraton ( a c t sheet, cue cards, poster and already-underserved rural areas. Tacoma will host the 98th WSMA orderforms for additional materials, if If approved, Initiative 92 Annual Meeting, Sept. 17-20. It needed. promises to be one of the best ever! On November 3,1987, will become the most The opening session of the House of Washington voters will have an Delegates will begin at 1:30 p.m., opportunity to vote on Initiative 92 on restrictive Medicare law Thurs., Sept. 17. Highlighting the a state-wide ballot. The ballot title of in the country. session will be Morris B. Abram, past i Initiative 92 reads: Chairman of the first Presidential "Shall it be a violation of the State This concern seems valid. An Commission for the study of Ethical Consumer Protection Act for doctors independent survey of Washington Problems in medicine. He will speak treating Medicare-eligible patients to physicians showed that as many as on "Where Science, Morality, charge more than Medicare's one-third would have to consider Theology, Law and Public Policy reasonable charges?" giving up their senior patient base to • • • remain solvent. Internists and family Intersect." Washington State Senator Phil i If approved by 51% of the voters, physicians would be especially hard Talmadge, Chairman, Senate this initiative would, in effect, mandate hit by Initiative 92. It was this concern about access to Judiciary Committee, will also speak at the acceptance of Medicare the opening session on physicians assignment for all physicians i n care that led the Washington State and the legislature working to improve Washington State who treat Medicare- Ch apter of the American Association of Retired Persons to oppose peer review and the medical eligible patients (physicians would disciplinary process. have the option of opting out of the Initiative 92 last year, and to reaffirm medicare program entirely) their position during the 1987 Sanctions allowed under the state's legislative session. The senior lobby Consumer Protection Act include civil and Common Cause also refused to fines, damages and injunctive relief. endorse the measure.

What Will It Do? If voters approve Initiative 92 this Jacqueline Jorgensen, MD Fall, it will become the most restrictive elected President of the Medicare assignment law in the Washington State Society country. Under its provisions, physicians must contractually agree to Change of address. of Allergy & Immunology. accept assignment 100 percent of Dr. Jacqueline Jorgensen, a the time when they treat any Medicare- The home phone number of Dr. Paul member of the Medical Society since eligible patient. Unless you are willing Schneider in the 1987 Pierce County 1974, was elected to a two year term and able to provide care at an average Physicians and Surgeons pocket as president of the Washington State of 40 percent to all of your elderly directory should read as follows: Society of Allergy and Immunology. I patients, no matterwhat their financial Dr. Jorgensen also serves as a circumstances, you will be prohibited 851-7535 member of the Executive Committee from treating rather than 851-7525 of the Board of Directors of the any of them. American Lung Association. Massachusetts, the only state so far to pass a mandated assignment law, implicitly allows physicians to treat Newsbriefs continued on next page. I Pnvate-pay elderly patients, and August 1987 The Bulletin 5 Newsbriefs Continued Sound to Narrows MSPC well represented! On a beautiful day made for running, over 6,500 runners participated in the 15th Annual Sound-to-Nanrows Run, Sat., June 13. Many members of the Medical Society participated in the 12 kilometer event that has become a tradition for many in the area. Several MSPC members and spouses placed in the top 200 of men and women. They were:

Men Position Name Age Time 102 Thomas M. Herron 31 44:46 109 Ronald G. Taylor 44 44:48 142 Andy Loomis 32 46.23

W om en 26 Donna M. White 35 51:22 (#1 35-39) 48 Verna L. Herron 30 54:21 (#9 30-34) 86 Suzanne Annest 36 56:57 177 Anita D. Silverman 40 1:00:36 188 Toni M. Loomis 31 1:00:49

Priorto the run it was announced that Dr. Cordell Bahn William B. Jackson, MD was one of the few runners who had run in every Sound-to- Mark E. Jergens, MD Narrows race since its inception. David R. Kennel, MD James M. Komorous, MD (51:18) Editors Note: The following is a list of MSPC members Michael Komorous and family members known to the editor who participated in David E. Law, MD (50:11) the run. Our apologies to those omitted. Please call in any John P. Lenihan, MD (53:12) omissions. Corrections will be run in the September Andy Loomis, MD (46:43) Newsletter. Toni Loomis Jan Mcllroy Glen H. Aasheim, MD Chris R. Miller, MD Suzanne Annest Julie Mueller Cordell H. Bahn, MD Jack Nagle, MD Stephen Bergmann, MD Pat Nagle Debbie Billingsley Michael W. Priebe, MD Dick Bowe, MD Janice L. Roth David Bowe Anita D. Silverman, MD Kathy Bowe Janice L. Strom, MD Lauri Bowe Ronald G. Taylor, MD Thomas K. Brown, MD Alan D. Tice, MD Shirley R. Deem, MD Jan M. Torgenrud James Dunn, MD Terry Torgenrud, MD Roald J. Graf, MD Dennis Waldron, MD Kenneth D. Graham, MD Lawrence J. White, MD Julie A. Gustafson, MD Donna White Jan M. Halstead Edward William, MD John M. Hautala, MD (50:17) Thomas M Herron, MD (44:46) 2.7 Mile Participants Vema L. Herron (54:21 - 9th in the 30-34 category) Verna Bergmann John C. Hill, MD Katherine Bergmann Judy M. Hill Erica Bergmann Sam J. Insalaco, MD (53:57) Sarah W. Bowe

Congratulations to all participants. You are all winners! 6 The Bulletin August 1987 MSPC Committee criminal penalties they face if they release information without on AIDS permission. Personal Problems The first meeting of the MSPC Third, keep abreast of new of Physicians developments. As more is Committee on AIDS under the discovered about the disease, Committee chairmanship of Alan Tice, MD, met changes are certain to occur on the and discussed the issues confronting legislative front. the medical community related to this Finally, if you have questions For Impaired Physicians growing problem. about the appropriate thing to do in Members of the Committee any situation, contact someone who Your colleagues want to help. represent the Tacoma-Pierce County handles AIDS issues on a more Health Department, School Nurses, frequent basis or contact the Tacoma- Medical Problems, Drugs, Hospital Social Services, Hospital Pierce County Health Department Infection Control and the Medical AIDS Project at 591-6407. Alcohol, Retirement, Auxiliary. (For further discussion on AIDS Emotional Problems It was reported that presently, in this issue see pages 14 & 15.) Pierce County has 33 reported cases Committee Members of AIDS. Of those reported cases, 80% have been gay or bi-sexual. The Patrick Donley, Chairman 272-2234 health department has tested and Robert A. O'Connell 627-2330 counseled 1,000 persons since 1985 John R. McDonough 572-2424 with 20% of those testing positive per western bloc. William A. McPhee 474-0751 The focus of the Committee will Ronald C. Johnson 841-4241 be to determine what resources are Jack P. Liewer 588-1759 presently available forthe AIDS patient and identify the future needs Dennis F. Waldron 272-5127 | of the community. Mrs. Marie Griffith 588-9371 Joint Meeting WSMA: 1-800-552-7236 of EMS and AIDS: Aging Committee MSPC EMS Committee members Office Protocols and the Committee on Aging held a * Many experts currently estimate joint meeting, June 25, inorderto that at least 1 million people have clarify "Do Not Resuscitate Orders" been exposed to the HTLV-III virus and improve communications with and up to 30% of these people will paramedics. develop some immune impairment. The difficulties primary care (LACMA Physician, Sept. 8,1986) physicians sometimes experience Over 25 sign up for Even if your practice does not always with paramedics were discussed by involve people in high risk categories, committee members. The availability Caribbean Cruise. you should establish office protocols of code/no code instructions at the Still time to now so you won't be caught off hospital, nursing home and family make your reservations. guard. resident continues to be a major First, train all people in your office source of problems for physicians and on proper procedures for handling paramedics. Give yourself a gift. Begin the blood or other body fluids and for Dr. Clark Waffle, Medical Director, New Year with nine relaxing and fun- disposal of needles and other Tacoma-Pierce County EMS System filled days in the Caribbean. There is materials possibly contaminated with a will draft protocols for the committees still time to sign up and join your patient's blood or body fluids. to review. It was emphasized at the colleagues in the Caribbean sun. Second, establish procedures in meeting that physicians can play a You’ll visit St. Marten, Antigua, your office forthe handling of leadership role in advising their Martinique, Barbados, the Virgin patient's records or research records. patients and theirlamily members on Islands and Puerto Rico. It's certain to The files of patients tested for HTLV- the importance of a living will and be an enjoyable and memorable III antibodies and the files of those having code/no code instructions on vacation for all who go. who have AIDS or ARC should the hospital and nursing home charts. Cost forthe Caribbean Cruise is contain a sheet of paper on top of all If you have had a problem approximately $2700.00. This records, inside the file, that states in communicating with a paramedic, it is includes airfare, meals, accomoda­ bold letters: "Absolutely no important that the episode be tions and much more. disclosure without patients written reported. The specifics of the For additional information call the consent. See doctor before releas­ incident need to be documented. Medical Society Office. ing any material.” Train your employ­ Call the Medical Society office when ees about the possible civil and such an incident occurs.

1987 August The Bulletin 7 Newsbriefs continued

Computerized Testing Doctor - Lawyer - f a i e a a t By F a ste st axtnyentf, Dentist Field Day Psychological, Vocational, Sept. 25,1987 Educational ICO.. Adult and Children The Doctor-Lawyer- Dentist Field Harold B. Johnston, MD, P.S. Day will be held Friday, Sept. 25. Union Avenue Pharmacy Alk'nmore Medical Center, B-3009 There will be three activities: golf, & Corset Shop South 19th & Union tennis and a running event. Tacoma, WA 98405 2302 S. Union Ave., Tacoma Telephone 383-2413 Following the conclusion of all three 752-1705 events, there will be a prime rib dinner at the Tacoma Golf and Country Club. Cost for the dinner is $25.00 per person. H I Quality Janitorial Service and Supplies Starting tee time for the golf | THE CLEANING COMPANY event is 11:30 a.m. at the Tacoma 2809 RocheaerWest-T«coma,WA98466. Ptiotw: 5*4-3215 or 545-1S1S Golf and Country Club. Entry fee is The Cleaning Company specializes in contract cleaning of $25.00. The tennis event will be held commercial buildings, schools, banks, and office buildings. at the Lakewood Racquet Club from Complete maintenance includes: Janitorial supplies. WeStSidO Supply 1:15 p.m. to 5:00 p.m. Fourindoor • Interior building cleaning • Paper and chemical supplies tennis courts have been reserved tor • Carpet cleaning * Floor machines, vacuums the tennis event. Entry fee is $10.00. • Grounds maintenance • Janitorial tools Entry fee, site and starti ng time for • Bonded & Insured * Mats, towel and soap dispensors the running event will be announced • Shipping: Free delivery with $50.00 minimum to 98465, 98466,98467 & 98405 at a later date. Free delivery with $100.00 minimum to all other Tacoma zips. Those who cannot participate in the events are still welcome to attend the dinner where prizes and awards will be given. For information call Gary Ross at 383-3791.

W o r k i n g S o l u t i o n s Professional Services Library Committee The Library Committee underthe For The Injured chairmanship ot Dr. Gil Johnston has 410 S.W. 153rd St. Seattle, WA 98166 been meeting to consider the options (206) 244-5460 available to it for reorganizing the >Seivin2jill_PierceandJ2n£iCounties^nearSe^acAir£or^ medical library. Presently the Medical Library is a loosely defined consortium made up Chronic Pain of members of the Pierce County Hospital council and the Medical M a n a g e m e n t Society. It has no contractual arrangements with either group. Intensive 3-Week Program Library personnel are not actually Return-To-Work Emphasis employees of the library per se or Multicare. Lines of authority, accountability, and managerial responsibilities need to be clarified. Physical Capacity Evaluations The Committee will weigh the advantages and disadvantages of incorporating. Time and expense Ronald S. Winkle, M.D., Director factors are major considerations the Committee will study. 8 The Bulletin August 1987 “When Grandpa got sick, I asked my Dad if I could go visit him at Manor Care AMA New s where he's staying till he gets better. You see. it’s really important, because I’m the family fisherman while Gramps is gone, and I come here every week to tell him how many fishes I caught.”

“I really like visiting Gramps at his place. Because they always let me see him. AMA Board no matter when I come. And the people here always give us good snacks - almost as good as the fish fry we're going to have when Gramps comes home.” recommends “But mostly I like it here at Manor Care because my Grandpa does . . . and no dues increase that's the most important thing of all." for 1988. The AMA Board of Trustees has Manor Care of Meadow Park CONVALESCENT AND REHABILITATION CENTER recommended against an AMA dues 5601 S. Orchard St. • Tacoma • 474-8421 increase for the third year in a row. The decision, according to the AMA, Medicare Certified will permit only modest growth in Association activities, and new projects will be initiated only if existing activities are reevaluated and possibly ‘I Told Gramps eliminated. The Board also concluded that a dues increase will About The probably be necessary in 1989. One That » Campaign financing reform Got Away.”

• Professional liability i • Biomedical research issues

■ Unrelated business income tax

• Physician Drug Dispensing l » Catastrophic Health Insurance Allenmore • PRO due process • Maximum allowable actual Medical Center cost (MAAC) implementation

• Aids Pierce County's most prestigious medical/dental facility. 22 acre campus adjacent to the 156 bed Humana Hospital, The Washington AMA office has Tacoma. Central location, easy freeway access. All inclusive hosted two Congressional retreats rental rates with suite construction allowances available. devoted to an examination of the AIDS crisis (funding, research, current treatment and information on its • Limited number of medical/dental causes). suites now available The AMA is committed to working with Congressional and Administration leaders in developing a rational, scientifically based (206) 383-2201 approach for dealing with the Al DS (206) 383-2086 epidemic.

Julie Labrecque, CPM, Business Manager S. 19th & Union • Suite B-1005 • Tacoma, WA 98405

1987 August The Bulletin 9 patients to consulting physicians. He In Memoriam searched constantly forthe best By Leo Annest, MD possible care for his patients. He always listened intently to their problems. He was never cross with Robert Gordon Bond, MD them, even though they were very 1915 -1 9 8 7 demanding of him, and he was always Sorrow came upon the family took place from 1947 to 1949. He eager to try and solve their problems. and the many patients and friends of began his family practice in 1950. He was truly a good family doctor. Robert Bond upon his death on I first met Robert in 1941 at He loved his family very dearly March 12,1987. Robert, the son of a medical school in Louisville. When I and was greatly saddened and plumbing contractor, was born in was a junior in the medical school, burdened by the death of Sally in Canada. He attended premedical Robert was my senior advisor. He was 1986. This sadness hastened his school at the University of Puget always a very hard working and death. He is survived by three Sound and graduated from the excellent student, and was very children, Steve, Nancy and Mary. He University of Louisville School of instructive and helpful. His interest in was a member of the American Medicine in December 1943. his patients and their welfare was very Medical Association, Washington It was at Louisville General evident, and this interest and care State Medical Association, Medical Hospital that he met his beautiful continued all through his medical Society of Pierce County, was a bride, Sally, and was married in March career. He influenced the lives of founding fellow of the American 1943. He served his internship at many people in Tacoma, extending Academy of Family Practice and a Springfield General Hospital from through the second and some third member of the Pierce County January 1 thru September 30,1944, generations of many of his original Academy of Family Practice. and then entered the armed services patients. His patients dearly loved His devotion and generosity in following his internship and was him, not only as a doctor, but as a the sen/ice of his patients and the discharged in 1946. His next service friend. A favorite term that I heard care of his family shall long be was a general rotating residency at about their expression of him was that remembered by all involved. May the Pierce County Hospital when it he was "Mr. Wonderful." He had no God's blessing be on his soul and on was a county charity hospital, and this interest in politics in the referral of his his surviving family. □ What’s new for physicians at St. Joseph Hospital?

♦ A S e c o n d C T S c a n n e r is n o w is use. ♦ Cardiac Cath Laboratory offering T h is GE 8 8 0 0 Scanner w ill h elp us p er­ angioplasty procedures and heart form more procedures and reduce wait­ catheterizations. ing time for you and your patients. This scanner supplements our state-of-the-art ♦ M obile Lithotripsy U nit for non-surgi- CT9800 Quick Scanner. cal treatment o f kidney stones. Litho­ tripsy van is available tw ice a m onth at ♦ Eating D isorder Center providing the hospital. treatment and education to help patients recover from anorexia, bulimia, compul­ sive overeating and other eating problems.

♦ Echocardiograph Color Doppler U ltrasound Machine. First in Pierce County. Provides a more detailed picture St. Joseph Hospital o f the heart and a better indication o f Caring Is Strong Medicine, Too. b lo o d flo w . For more inform ation, call 591- 6767.

10 The Bulletin August 1987 The "Do's and Don'ts" of Being a Medical Witness...

Once financial arrangements but be prepared to justify any contrary opinion of authorities will not have been settled, what does the omissions. necessarily discredit you. doctor need to do when he testifies? What is expected of him? What * Don't exaggerate. Any attempt to * Don't be smug. A jury is quite likely should he say and not say? A safe puff up your qualifications or to to react adversely to an attitude of this rule of thumb is, "Confine your elaborate the extent of the nature. A modest attitude on the part answer to the question asked, and examination you have made is apt to of a witness is apt to elicit a more don't volunteer additional be exposed. favorable response. Leave it to the information," but a list of guidelines attorney to bring out your special was drawn up by LACMA’s former * Do inform the attorney for the party qualifications. legal counsel, now retired, Frederick who called you as a witness of all 0. Field. His advice follows. unfavorable information developed * Do be courteous no matter what the by your examination of the party, as provocation. If a cross-examining * Do take the role of the medical well as the favorable information. attorney is discourteous to you, this is witness seriously. The courtroom is a apt to win sympathy for you from the place in which practical men are * Don't try to bluff. If you don't know jury, provided that you don't descend engaged in the serious work of the answer to a question, don't to the same level. endeavoring to administer justice. guess. If you guess wrong, you may The role of the medical witness is a be falling into a trap. * Don't lose yourtemper. If a cross- key one in this endeavor. examining attorney can provoke you * Do be frank about financial to a display of anger or sarcasm he * Don't agree to, or accept, arrangements with the party who has already substantially succeeded compensation for your services called you as a witness, with respect in discrediting your testimony. contingent upon the outcome of to your compensation for both litigation. This practice is unethical treatment given and services in * Do pause briefly before answering a and its disclosure would be apt to connection with the litigation. question asked on cross- destroy the value of your testimony. examination, to give the other * Don't regard it as an admission of attorney an opportunity to object if he * Do insist on preparation for your ignorance to indicate that your so desires. Taking a moment for testimony in consultation with the opinion is not absolutely conclusive deliberation before answering a attorney forthe party who called you orthat you don't knowthe answerto a question does not indicate as witness. He should advise you on particular question. Honesty may uncertainty or embarrassment. what to expect on cross-examination. frequently require testimony of this It is proper to consult with the party nature. * Don't allow yourself to be forced and his attorney about the case, so into a flat "yes" or "no" answer if a don't be embarrassed if asked about * Do answer all questions honestly qualified answer is required. You such consultation. and frankly. Any display of have a right to explain or qualify your embarrassment or reluctance to answer if that is necessary for a * Don't act as an advocate or partisan answer will tend to discredit your truthful answer. in the trial of the case. If the attorney testimony. forthe party who calls you as a Some of these guidelines apply witness needs the advice or guidance * Don't use technical terminology to percipient witnesses, some apply of a doctor during the trial, let him which will not be understood by the to expert witnesses.D employ another doctor. Disclosure of jury , the attorneys or the judge. If partisanship of a witness strongly technical terms are unavoidable, Reprinted from: LACMA Physician, tends to discredit his testimony. explain them the best you can in the October 6,1986. language of the layman. * Do be as thorough as is reasonably necessary under the circumstances in * Do be willing to disagree with so- examining a party in preparation for called authorities if you are convinced trial. Exhaustion of all possible tests that they are wrong. If you have and procedures may not be required, sound reasons for disagreement, the 1987 August The Bulletin 11 V

was of a neurologist, holding my mother's hand, gazing into her eyes, whispering of primal cells, A Death in the Family preconsciousness, and the end of purposeful life. She could not have By Lawrence R. Ricci, MD understood much of what he said, yet Waterville, ME she knew. She knew unmistakably the language of his heart and the syntax of his tears. I remain grateful to that healer. As my father lay brain dead, only On Aug. 24,1982, at 3:13 AM father. He reviewed the medical then did the medical forces of comfort in a large metropolitan teaching record, spoke with us, listened to our and caring mobilize themselves. hospital, my father, at the age of 72, concerns, and offered Nurses and doctors approached to died of complications from diffuse encouragement. US residents, console us. Their aid by then was histiocytic lymphoma. During his brief perhaps more technically advanced unnecessary. We knew what had hospitalization, we, his family, but seemingly colder, wouldn't do happened. We knew what was experienced his leaving the modem that. US medical students might. But required of us. We had mobilized ^ :r American way: an odd mixture of cold somewhere in the transition from own resources. Six hours later, my lighting, bright machinery, and rare, fatigue and degradation to skill and father died. unexpected warmth. confidence, from student to I belie. e I am a competent, My first glimpse of my father in physician, we defer compassion, put caring physician, often afraid, the hospital startled and humbled me. it aside, often forever. sometimes callous, rarely petulant One month before, he had been a A corps of nurses, ranging from and childish. I hope I can hold on to fully functional, retired machinist. the least skilled aide to the most the memory of my father's death, not Since then, cancer, malnutrition and skilled postgraduate diplomate, only for myself, not only for my father, dehydration had transformed him into buttress modern medical science. I but for my craft, for my patients. an invalid. A screen exists between recall only fleeting views of many From The Journal of the American Medical the way we see ourselves and our strangers: one nurse forced me to leave my father's bedside after I had Association, May 8,1987 - Vol. 257, No. loved ones and how modem 18 medicine sees us. I recall my traveled 500 miles to see him so she confused and saddened brother could administer an enema on describing how a nurse had asked schedule; another nurse, when I Crossroads Treatment Center him if our father could iva//cwhenhe requested pain medication for my had been home. dad, impatiently replied that it wasn't Alcoholism Forthe most part, his physicians time yet, adding as she quickly turned A Program Designed to Provide were competent. To me they were to chart her notes, "Anyway, the pain Comprehensive Treatment for deferential; to my family, med will drop his blood pressure All Facets of Alcoholism condescending. Teaching hospital again." Exhausted and afraid, I stood medicine - the trickle of diagnosis, the silently at her desk. Drop his blood Physician Directed flood of therapy, agonizing waits for pressure? Again? I dont understand. prognosis, headlong therapeutic Is my father dying? Will you please Family Treatment Included stop writing and talk to me, stop adventures, students, residents, Cost Effective Outpatient attendings, surgeons, internists, talking and listen to me? If I, a Program hematologists, oncologists, physician, didn't understand, how nephrologists - even I couldn't keep it much less did my family understand? Covered by many Health all straight. What about families with no Insurance Plans Some memories pain me more knowledgeable relative to intercede than others: the angry, impatient and interpret? FOR INFORMATION surgical resident who wouldn't The final day. Code 99. Did the CONTACT: understand my frightened mother's nurse pressing herweight into his Ted Berning, Administrator indecision about a minor surgical chest know him? Did the resident 5909 Orchard St. West touching 400 joules to his heart know procedure; the enthusiastic medical Tacoma, WA 98467 student who asked excitedly if I had him? Did he remind them of their palpated my father's abdominal mass; own? Did they touch his body with (206)473-7474 the uncertain medical resident who respect? Nearing the e nd ... his asked my opinion of Dad's BUN and pupils fixed and dilated... his skin blood sugar, who asked if I concurred cool and mottled... his heart beating with the insulin drip calculations. How but his spirit dead. I clutched at a could I answerthese questions? I'm crumpled ECG strip, the rising and CROSSROADS not this patient's doctor, I'm his son. falling electrical imprint, found lying in TREATMENT One memory was not as painf u I. his room, now in my wallet pressed CENTER A resident from India came in on his behind his 1942 photo by a tent in An Approved Washington Alcoholism night off to see my father because, he North Africa. Treatment Facility said, he was reminded of his own The final memory, the best one, 12 The Bulletin August 1987 Furthermore, in the absence of instructions, family may be in the best Editorial Comment position to say what the person would have wanted; the important part is O f l what the individual would have Memories wanted. The last few years we seem By Richard Hawkins, MD to be evolving toward greater self- determination. "He, who dies with the most memories, wins. When does death occur? That discussion could go on for ever. Happy times and pleasant death, albeit by a different definition Actually, maybe it has. experiences make for good of brain death. When should death occur? memories. Who does not like to have I think we have all heard it said I do not think that we can come good memories? But what happens that some approach life with the to agreement on these questions. when you do not have any new attitude that he, who dies with the I like the idea of people deciding memories? Sometimes things most money, wins. Or even, he, who for themselves. Decide for yourself happen that you remember, but that dies with the most toys, wins. under what circumstances you want you would not call good. Even bad Many of my family, friends and to continue living, under what memories might be betterthan no patients have expressed concern that circumstances you would not want to memories at all. If, for whatever they do not want to live as a continue living. reason, you do not have any new vegetable. They have seen folks who So, I get to choose my own memories, does that signal the end of have lost mental function, with or definition of quality of life. useful life? That would be like what without physical disability, who are not I choose memories.□ some people refer to as being a really aware of what goes on around vegetable. Ithinkitwouldbelike them, are not able to participate, and, I The opinions expressed here are those of being brain dead. presume, do not remember what the author and do not necessarily We do have a clear procedure happens. represent the opinion of the Medical fordetermining when a person is In recent decisions courts are Society. Comments or contrasting brain dead -- a very useful procedure affirming a person's right to participate opinions are encouraged. Write to The in some situations. But I think it in the decision about when and under Editor. misses some important cases of brain what circumstances death occurs.

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1987 August The Bulletin 13 E

AIDS Update

By Steve Heilig, MPH, Staff Associate San Francisco Medical Society

HIV Antibody Testing: concern and risk regarding AIDS is Potential risks of antibody Basic Considerations for not limited even to these broad testing include: Practitioners groups, and evaluation of potential 1 . severe psychological Publicity about the continuing candidates fortesting should be reactions, including anxiety, spread of AIDS has heightened done on an individual basis. nightmares, sleep disturbances, public concern about HIV infection Some AIDS experts now depression and suicidal behavior; and antibody testing. While many recommend that every sexually- 2. disrupted interpersonal AIDS experts and medical active patient should be counseled relations, including potential for rage organizations have issued statements on how to avoid exposure to HIV, reactions and their extreme manif in favor of antibody testing for regardless of whether the test itself is estations, such as homicidal behavior individuals in high risk groups, serious an issue (see Goedert, 1987). For 3. social ostracism and self- concern about AIDS - and AIDS itself - anyone considering the test, full imposed withdrawal; has now spread beyond those awareness of the potential "pros and 4. relationship problems (blaming groups, with antibody testing sites cons" of testing shou Id be a goal for partners, sexual dysfunction, and health care providers reporting a both patient and physician. disrupted ability to make plans as a substantial increase in the number of couple); people asking about or requesting Potential benefits of antibody 5. stigmatization and discrimina­ the test. Physicians are being urged testing include: tion if a positive antibody status is to counsel patients appropriately both 1 . to protect the blood supply by made known to others outside of before and after testing, and not to testing individuals who are guarantees of confidentiality; assume that patients are aware of the considering donating blood; 6. problems with employment or many implications of HIV antibody 2. to ensure that organ donations insurance; testing. However, solid information are safe from HIV contamination; 7. preoccupations with bodily on counseling patients regarding 3. to help support a medical symptoms; and, antibody testing has not been widely diagnosis in individuals who exhibit 8. a false sense of security and available. unexplained symptoms that their denial if the test proves negative (for The following information has doctors think might be related to HIV example, believing one is immune to largely been excerpted from recent infection; infection and thus continuing with risk publications on the subject and is 4. to help women at high risk behavior). (From Goldblum & intended to convey only the most decide whether to become pregnant Seymour, 1987). basic considerations regarding this or give birth; complex and often controversial 5. to help women with a history of It should be noted that all of these issue. risk behavior decide whether to considerations are not theoretical but breastfeed an infant or have an infant based upon continually expanding Pre-Test Counseling: innoculated with vaccine produced experience with HIV testing. In every The primary purpose of pre-test from living virus; case it should also be made clearthat counseling is to enable the patient to 6. to motivate individuals who the antibody test is not a test for AIDS make an informed decision regarding continue to practice high-risk itself, but for infection with the AIDS whether or not to be tested. behavior and who feel that a positive virus, and that a positive test does not Physician counseling regarding HIV test result may help them reduce necessarily mean a person will antibody testing and AIDS in general these behaviors; develop AIDS or AIDS-related should be directed particularly to 7. to help researchers design conditions. patients in the highest- risk groups, experimental treatment protocols and including homosexual or bisexual to help potential subjects determine Post-test couseling: men, prostitutes, heterosexual men whetheror not to participate in the For patients with either positive or and women with multiple sex drug trials; and, negative test results, physicians partners, patients with a history of 8. to help scientists determine should offercounseling on low-risk sexually-transmitted diseases, the extent of HIV infection in the pop­ sexual and substance abuse behavior intravenous drug users, and patients ulation at large and, by following sero­ where appropriate. Handouts with from HIV-endemic areas such as positive individuals, to understand central Africa or Haiti. However, the natural history of HIV infection. Continued on next page. 14 The Bulletin August 1987 X , ------■/ Aids Update continued from page 14 this information, such as those The San Francisco anonymous Francis, DP, Chin, J: "The Prevention of produced by the San Francisco AIDS testing site is at Health Center 1,3850 Acquired Immunodeficiency Syndrome in Foundation, are now widely available. 17th Street (at Noe), 621-4858. the United States" JAMA 1987:257:1357- In almost every case, positive test Another testing site will open in June 1366. results should be given to the at Health Center 2, 1301 Pierce Goedert, JJ: "What is Safe Sex?" patients in person. Patients who are Street ( at Ellis). Further sites will be Suggested Standards Linked to Testing for seropositive should be evaluated for opening in September in the Bayview- Hunters Point, Mission, Tenderloin Human Immunodeficiency Virus" NEJM HIV-related symptomatology. It is 1987;316:1339-1341 extremely important that seropositive and South of Market districts. As of patients be counseled on howto mid-May, health officials report about Miller, D: "HIV Counselling: Some Practical avoid exposing others. Psychological an eleven-week waiting list for the Problems and Issues." JRSocMed 1987: counseling may be indicated. free and anonymous tests. 80 (5):278-281 Continuing evaluation and counseling should be made readily References (for details, call Steve Heilig "What to tell patients about HIV test.” available, with follow-up visits for at the SFMS): Interview with Neil Schram, MD, in American seropositive patients scheduled Medical News, American Medical Goldblum P, Seymour N: "Whether to Take Association, April 3,1987. about every three months. the Test: Counseling Guidelines" FOCUS: Resources such as support groups A Guide to AIDS Research. UCSFAIDS for seropositives and women are Health Project, April 1987. available locally. In addition, for patients with Jacobsen MA: “Laboratory Evaluation of recent high-risk behavior but a AIDS and ARC Patients’ AIDSFILE, SFGH negative test, retesting after a period AIDS Research Fund, December 1986. of approximately six months will provide additional assurance of negative status. In most individuals, antibodies appear within several weeks, although seroconversion has been observed to occur up to six months later.

Confidentiality concerns: THE DOCTORS’ EXCHANGE In order to ensure confidentiality, ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY some physicians do not record HIV test results or related information in the patient's regular chart, but use code systems or separate charts. The local alternative test sites do not require the names of people ...Another First requesting testing. Seropositive patients should be alerted to the Why settle for just potential risks of disclosing their a phone number? antibody status to third parties. Physicians should keep in mind With the new that disclosure of test results to any Information third party is currently illegal under Display Pager State and local law without a specific you can receive written release from the patient. It is patient name, also illegal to test any patient without nature o f call priorconsent. Investigation of these AND telephone No. issues is underway in many places INSTANTLY! including at the San Francisco Medical Society, and further Office: 272-4111 discussion will appear in the future.□ Exchange: 272-3166 Locally owned and operated. For informational materials regarding HIV antibody testing or other AIDS-related issues, contact 908 Broadway, Suite 201 the publications department of the Tacoma, WA 98402 San Francisco AIDS Foundation at 861-3397.

1987 August The Bulletin 15 A Week, If We Treat It... Seven Days If We Don't

By Lee A. Norman, MD

Seven days, a week, that's how and as patients what is expected? In RARE COINS long it takes to get better from the All's Well That Ends Well, common cold. Presuming the appropriately enough, Shakespeare MAKE MONEY diagnosis is correct and that the wrote, "Oft expectation fails, and most FOR OUR CLIENTS... illness symptoms are caused by one oft there where most it promises." of the usual respiratory viruses, that is When comparing our medical what it takes, no matter what technology and system of treatment I prescribe. Unfortunately, entitlements to other nations of the During rhe posr 10 yeors rare coins most patients are disappointed by the world, ours is certainly the land of hove outpaced oil, gold, silver, implication that little can be done for promise. I think that it is from this diornonds, even real esrore. os o them, except, perhaps, some minor background of relative health care superior investment averaging symptom relief (which usually, I abundance that patients and over 20% annual appreciation suspect, they feel is not worth the physicians alike enter a collusive If you'd like more information office charge). I nan effort to please, agreement that can lead to regarding building your own, personal I've even taken to quoting Tolstoy: disappointment and failed rore coin portfolio please qive me a The strongest of all warriors are these expectations. In such relationships, coll two - Time and Patience. Still not many physicians are reluctant to Here or HRCI we guoranree what w e sell, and whether you 're o new impressed. Theytold m ein medical explain the limitations and drawbacks school that my patients, knowing their investor or a seasoned professional we of diagnostic and therapeutic offer illness was nothing more serious, modalities, which in turn, can lead to would be contented with my over-utilization of health care ■ INSTANT LIQUIDITY . . . Published pronouncement. Not true! bids th a t g iv e PCGS cash volues resources. The outcome can be or any rime. Such observations have given expensive and uncomfortable for the ■ LIFETIME GUARANTY of coin me reason to question some of the patient, especially considering that authenticity basic beliefs I have about what often only a marginal benefit was ■ GUARANTEED REPURCHASE patients and physicians expect when expected from the start. Patients, in a g re e m e n ts we enter into a doctor-patient turn, are anxious to please us. This ■ COMMISSION FREE counseling relationship. Our country has one of takes a variety of forms. They may be and sales seivice the most sophisticated health care unwilling at the onset to state what ■ UPDATED statements of value delivery systems in the world, and we they truly expect from the encounter ■ PEACE OF M IND . . , W ith g u ar­ have made great advances in disease because of a "doctor knows best" a n te e d PCGS c o in g ra d in g treatment and prevention. And yet, attitude. Some are reluctant to fully ■ A 15-day return privilege the common cold, most cancers, and disclose the reason forthe visit for If you re o collector or on investor. . . HRCI AIDS, for example, remind us that we fear of discovering that something wonts to worii with you to build o profitable have a long way to go to cure many could really be wrong. Some portfolio. diseases. I remember when things physicians demonstrate an air of used to be simpler. Fifteen years ago omnipotence that tends to control the # HERTZBERG fishing in northern Minnesota a patient and the conversation. People S t * Rare Coin Investments, Inc. physician mentor, Howard Reid, took like to see doctors who appear a drink from my can of Grain Belt by confident, without being arrogant. I"Please send me more rare coin information! mistake. When I pointed out to him Doctors enjoy patients who are i N om e . that he was drinking my beer, he gave interested, honest, and involved with Address it back and confidently stated, "I’m not their own care but do not control or worried. You don't have anything that monopolize the encounter. On both I can't cure." sides, delicate boundaries separate Phone Now I realize that fortunately it the proper from the improper in was true. His rather pompous and physician and patient behaviors. naive comment seems an Difficulty in communicating each 535 DOCK STREET. SUITE 204 anachronism, given the assortment of others' expectations is certainly not a TACOMA. WA 98402 nearly-incurable diseases we new phenomenon and is not unique (206) 627-2883 or 1-800-826-0039 recognize today. As physicians what is promised, Continued on the next page. A BONDED, LICENSED PROFESSIONAL

16 The Bulletin August 1987 \ — — A Week, If We Treat continued from page 16

to the field of medicine. As health address their concerns. culture medium for them. Butin care becomes increasingly technical, In my own practice I'll continue listening and talking with patients, in however, we rely less upon the to quote Tolstoy in an attempt to asking their opinions and in treating painstaking subtleties of a meticulous make more palatable the bad news I their pain, I hope they know that I hear history from the patient and a have for some of them: you have a their concern, respect their insight, thorough hands-on physical cold. I may even go on my tirade and am willing to act as a partner in examination. Many patients feel that against viruses, that they are the true, health and illness during these times they have been rushed through their rightful heirs to this planet, and that of change.D office visit, which included only a brief our place is only to serve as a history (I don't think he heard me), a sophisticated, albeit complaining, From: King County Medical Society superficial examination (The doctor Bulletin, June 1987 hardly examined me), and a request forfurthertesting to be done (I don't even know what the tests are for). As Octavio Paz wrote, in 1967, "Alienation... is the very nature of technology: the new means of communication accentuate and strengthen noncommunication." In many patient encounters, doctors simply rely too heavily on technical (C associates procedures and bypass that good old- fashioned cornerstone of our medical practice that patients find so SEARCH RETRIEVE CORRECT rewarding: communication, i Lest I be perceived as unkind to se RE' co associates will provide a resource to the my brothers and sisters in the medical community for problems with: profession, I will say that there are forces within the field of medicine that • Accounts Receivable: A search of accounts receivable with appropriate make poor communication more hands on measures for recovery and stabilization to include A/R controls. likely. Alvin Tofflercalled it “future • Office Management: Survey and make recommendttons for upgrading the shock", the "dizzying disorientation efficiency of the office with regards to procedures, materials, equipment, brought on by the premature arrival of space, and staff. ' the future," which induces stress in individuals by subjecting them to too • Accounts Payable: Assist with A/P intra-office bookkeeping controls much change in too short a period of for more effective interface with accountant. time. Doctors often do not know how to cope with the changes in • New Office: Provide the actual coordination of appropriate equipment, technology, and there is no easy supplies and procedural guidelines, to include augmentation training of solution to the problem of how personnel as needed. physicians keep their medical Specializing in crisis management knowledge current. To hide with over 15 years combined experience uncertainty in noncommunication makes us just as much a victim of 927-6540 change as our patients. We are still 14310137th Ave. E. expected to talk to our patients in Puyallup, WA 98374 language they understand and to

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1987 August The Bulletin 17 From Membership Benefits Inc. Make The Right Decision "The First Time." By Sharon Bain

It is very important to employers 3) Look for the person best suited. true reflection of your instincts or they to make the right hiring decision 'Ihe Construct the interview so you will can be signals telling you to beware. first time." Hiring a new employee will have a better view of how well the always involve a certain element of applicant might fit in with your Professional interviewing takes risk. Learning and using good particular group. Will he/she have to practice and patience. Evenafteryou interviewing techniques will not make too many adjustments in have improved your interviewing skills eliminate risk, but will greatly increase temperament, personality, or work there will be no quarantee that you will the chances of successful hiring. habits to "fit well"? not make a mistake in hiring, orthat a First, define clearly the actual solid candidate you hire will not work skills and experience necessary for 4) Strive to improve your questioning out. But by becoming more proficient each position and prepare a written skills. Become adept at asking open- and detailed each time you conduct job description. This will be of great ended questions, those that cannot an interview, you will increase greatly value in the screening process. be answered "yes" or "no." Keep the the odds for success. Common errors made by questions flowing and build your It is important to learn about the interviewers include: lack of listening skills. proper questions to ask during an preparation, lack of interviewing interview to stay within the limits of the technique, not enough time allowed, 5) Always allow the applicants to ask Human Rights Laws. If you interview an atmosphere that is stressful or enough questions of their own. Allow properly, an applicant will usually intimidating, uncertainty about the enough time and the right relate to you all you desire to know job’s requirements and not knowing atmosphere encouraging the about them without asking questions the types of questions to ask. applicants to ask the questions which could be in violation of the law. Remember, an interview is an important to them. Often an If you are concerned about which opportunity to engage in active applicant's questions will reveal questions legally can and cannot be conversation resulting in an his/her needs, hopes and asked of applicants, please contact exchange of information helpful in expectations. They will help in your your Membership Benefits office at making a hiring decision. judgment of the applicant's potential, 572-3709 and information will be sent Here are a few suggestions to suitability, motivation and attitude. to you. help sharpen your interviewing skills: Make"special" note of the first Remember, effective question the applicant asks. There is interviewing is essential in the 1) Analyze the job before you a world of difference between "How process of selecting a new employee. interview any applicant. Write down many days of sick leave would I Hiring the most suitable person is vital specific job requirements and have?" and "How many patients do to your office productivity, employee personality traits you feel will be you see each day?" morale and, consequently, to the needed for this position. You may success of your practice.□ want to brainstorm with another 6) Arrange a second interview for final person to obtain these requirements. candidates. Usually, a second interview will produce a more relaxed atmosphere and may provide an 2) Make a written plan. Make notes to answer if you are having a difficult time use as a guide during the interview, making a choice. such as: Identify the applicant's Featuring objectives. Ask about short and long 7) Use your instincts. Listen to your Tacoma's Finest Homes term goals. Identify the applicant’s inner voice and let it guide you to skill and potential. Ask about his/her what would be the best choice. Learn accomplishments and the things of to use your instincts more and to trust Richard C. Pessemier which he/she is most proud. Identify them. Sales Associate what motivates this person: money, power, achievement, recognition or 8) Always make notes after each 272-4138 OFriCE 759-2699 HOME challenge? Identify the applicant's interview. After each interview quickly sense of values. Ask about the make notes to yourself before going Swanson-McGoldrick, Inc. best/worst job the applicant has had on to another task. Rely on these W A S H IN G T O N B U IL D IN G SUITE 302 and the best/worst boss. notes later because often they are a T A C O M A . W A S H IN G T O N 9B402

18 The Bulletin August 1987 Reporting Preventable Diseases

As a result of two years of hearings and input from health care providers, the State Board of Health has issued a revised list of reportable diseases that became effective June 19,1987. Copies of the list were mailed to all physicians, infection control practitioners, lead school nurses and other health care providers. The form for reporting sexually transmitted diseases was also revised. Please discard all previous STD reporting forms you may have and begin using the new forms immediately. WAC 248-100-076 Reportable Diseases and Conditions

The following diseases and conditions shall be reported as individual case reports to the Tacoma-Pierce County Health Department in accordance with requirements and procedures described in chapter 248-100 WAC:

hatfGORY A DISEASES require an immediate report at the time a case is suspected or diagnosed and include:

Anthrax Paralytic Shellfish Poisoning Botulism (foodborne, infant, and wound) Plague Cholera Poliomyelitis Diptheria (noncutaneous) Rabies Measles (rubeola)

CATEGORY B DISEASES OR CONDITIONS require a case report within one dav of diagnosis and include:

Brucellosis Paratyhoid fever Gastroenteritis (if susp. foodborne/waterborne) Pertussis Haemophilus influenzae invasive disease Rubella (incl. congenital) (excluding otitis media) Salmonellosis Hepatitis A and B, acute Shigellosis Leptospirosis Syphilis (primary, secondary, early latent or Listeriosis congenital) Meningococcal disease Typhoid fever (incl. carrier)

CATEGORY C DISEASES OR CONDITIONS require a case report within seven davs of diagnosis and include:

AIDS (incl. CDC Class IV) Nongonococcal urethritis Amebiasis Pelvic Inflammatory disease (acute) Campylobacteriosis Pseudomonas folliculitis Chancroid Psittacosis Chlamydia trachomatis infection Q fever E. Coli 0157: H7 infection Relapsing Fever Encephalitis, viral Reye Syndrome Giardiasis Rheumatic fever Gonorrhea Rocky Mt. spotted fever Granuloma inguinale Syphilis - other Herpes simplex, initial genital infection Tetanus Herpes simples, neonatal Tick paralysis Kawasaki syndrome Toxic Shock Syndrome Legionellosis Trichinosis Leprosy (Hansen's disease) Tuberculosis Lyme disease Tularemia Lymphogranuloma venereum Vibriosis Malaria Yersiniosis Mycobacteriosis, including tuberculosis Severe adverse reaction to immunization Mumps

Any cluster or pattern of cases, suspected cases, deaths, or increased incidence of any disease or condition beyond that expected in a given period which may indicate an outbreak, epidemic, or related public health hazard shall be reported immediately by telephone to the local health officer. Such patterns include, but are not limited to, suspected or confirmed outbreaks of foodborne or waterborne disease, chickenpox, influenza, viral meningitis, nosocomial infection suspected to be due to contaminated products or devices, or environmentally related disease.

TO REPORT, CALL: CD 591-6410 • Hepatitis 591-6535 • AIDS 591-6060 ■ STD 591-6407 Environmental Health 591-6450 1987 August The Bulletin 19 "Building a Positive Future Together"

An Essay By Herbert R. Glodt, MD

Editors Note: The following essay, "Because a physician lives in THE DOCTOR REMEMBERED. written by Herbert R. Glodt, MD, a each of these worlds, tasting a little of Joe worked at GE's heavy retired Pittsfield, Mass. internist, was each, never satiated with either one. transformer. He'd just been the winning essay in a contest Let me tell you a true tale to promoted to foreman. They had sponsored by the medical societies demonstrate my point." purchased theirfirst home. A baby and hospitals in the western was next. But no baby came. The Massachusetts counties of Berkshire, thought of adoption left them cold. Franklin, Hampden and Hampshire. They wanted theirbaby, their family. Dr. Glodt has generously given She had Rebel of the Sixties Hope was waning when Mother came permission to publish his essay in this written on every feature of her to The Doctor. Big words and lots of issue of The Bulletin. The purpose of unadorned face and unbrushed Afro. tests, she thought. But no baby. The the essay contest, "the brainchild of She sat as far from her mother as the Doctor listened. Dr. Mike Magee, director of provider small consultation room would allow. He didn’t hurry her. He really relations at Baystate Medical Center, "I'm not 'high on dope half the listened. That stuck in her mind. He Springfield, Mass.," was to "rally time,'for God's sake, Mom, I'm not listened. He was interested. He support among physicians for their 'sleeping around with every jerk on offered hope, and she needed that own profession while showing the the block.' And I don’t spend all my more than anything. Even after 18 public that they really are sensitive day rockin’ androllin."’ years she had no difficulty recalling human beings" The contest drew The Mother recoiled under the fatigue, the trouble she had doing entries from more than 20 doctors the blast, ran a nervous hand over a ordinary housework, the skipped and medical students. pale, thin cheek. She dabbed at her period that gave them hope, the eyes with a tiny, wrinkled negative pregnancy tests that, once handkerchief and made sniff ly noises. again, brought despair. Wonders of The Gray-Haired Man and the The Doctor sat behind his cluttered wonders. The Doctor did not say, as student walked along the beach. The desk and spoke into the phone. had her friends, "It's just man did most of the talking. "I told Barbara that if it weren't nervousness. Get hold of "There are many worlds out for you, doctor, she wouldn't be here. yourself. Why don't you and Joe take there." He spoke slowly and I’m sure you don't recall, doctor. You a vacation." deliberately, stretching out both arms have so many patients. ltw as17or She recalled how she spilled to encompass both land and sea. 18 years ago. For two years Joe and I out all her symptoms. The Doctor "Two appealed to me. One world is had been trying to have a baby. probed for more. Tired. God she was filled with ceils that sprang from this Remember, you had Joe have a tired. Her hair. What a mess. ocean. It is a world branded with sperm count. No, of course you Couldn't do a thing with it. She double helix bits that breathed wouldn't remember. Anyway, he looked so old. That damn "Oil of immortality into all living things. It is was OK. It was me. Good Lord, I'm Olay" was for the birds. She felt bathed in cool logic and just gabbing and wasting yourtime." encompassed by numbers that physically cold and, what was worse, "Go on," said the Doctor. "If sexually cold. Joe was patient and extend to infinity." The Gray-Haired it's on your mind, it's important." Man paused to stare out over the gentle. But a man is not made of "Thank you, doctor. I went to water. He resumed his walking and wood. the gynecologist who said everything The Doctor checked her. his talking. below was normal. Then I came to Thoroughly, no hurrying, just enough "Fire and ice, storm and you for the first time. You got me tranquility engulf the second world, it small talk to keep her relaxed. Then pregnant." those wonderful words: is made of sadness and joy, hatred The Doctor laughed. The "I think I know why you canl and love, raw greed and God-like Mother blushed. "You know what I conceive. The history, the slow pulse humility. It is the world of people mean," she stammered. even when you are upset, the dry struggling for a Happy Day.” The laughter cleared the air. skin, the cold feeling, your reflexes all The Student interrupted. Barbara sat back and smiled. The voice was heavily flavored with suggest an underactive thyroid. Mother continued. "I told Easily corrected with a once-a-day impatience. "You began all this when Barbara the story. That's when she I asked why you suggested I become pill." agreed to see you. I'm sure you don't Continued on the next page. a physician. Why?" remember." 20 The Bulletin August 1987 Building a Positive Future Together continued from page 20 Mother's spirits soared but snuffed out the cigaret on the bottom children, their students The ripple crashed with a black thud when The of her sneaker. Casually she shoved effect." Doctor said: the butt into her pocket. She rose and kissed him "We'll need a confirmatory "I wonder if Barbara and I lightly on the forehead. "I'm proud blood test." could talk alone?" The Doctor asked. that you're a physician," she said. Anothertest. Anotherwait. "Certainly, doctor," Mrs. The Doctor sipped his coffee Another false hope. But the test did Colten left. slowly. "I've always thought of it in confirm. The little thyroid pill did work The young lady and The terms of joy ratherthan pride. A joy its magic. One year later, Barbara was Doctor talked for half an hour. The and a privilege. Sounds a little corny, born. Mother remembered. Some phone rang. but that's how I feel. It's all in that things you don't forget. Ever. No "Emergency room on line letter. Problems, pride, joy and tears. matter how many years. No matter two, doctor." Medicine has it all." how many patients. For Mrs. Colten it "Got to go, Barbara. If I can was the little slice of time that made help, please call. My grey hairs don't life worth living. For The Doctor that mean I've forgotten the problems of The Grey-Haired Man and his young spark that made medicine worth age 17." friend shook hands. The Student practicing. smiled and said: "I’ll think it over.TI THE DOCTOR neversaw "THERE’S NOTHING Barbara again. Twelve years went by. Reprinted here with permission: WRONG with me, doctor," said His secretary brought in a letter American Medical News, May 22/29,1987. Barbara, standing up and stretching. marked "PERSONAL." The Doctor Her tight-fitting jeans and the fullness read it, reread it, and smiled. It went of her breasts jutting through the as follows: Advertise in slopping, grey sweatshirt, and the full- 26Gracey Terrace of-youth blue eyes spelled out The Northampton, Mass. The Bulletin Me Generation/The New Wave. May 5,1985 For Information Call: "Mom thinks I'm on dope and sleep Dear Doctor: 564-3839 or 572-3709 around. I'm not and I don’t. My school Several years ago you and I grades stink. I admit that. I just don't had a chat in your office. You see any point in grinding away. The had my Mom, upset by my thought of four years of college deteriorating school work and teen­ leaves me cold. They'll probably age meandering, leave the room. We rFfolAPER RASH^L throw me out of the honors program. talked for some time. Perhaps half in IS NOT A WAY OF LIFE All A's last year. Flunking everything jest, you said: "You're not being fair to this year." She pulled out a pack of us old guys, Barbara. We depend on You can recommend professional diaper service with confidence. cigarets. "Mind if I smoke?" you to carry the ball so we tottering "Yes. I prefer no smoking in oldsters can sit back and relax. We • Laboratory Controlled. Each month this office." need you. The community needs a random sample of our diapers is Barbara lit up. Testing, you. The country and this fouled-up subjected to exhaustive studies in a thought The Doctor. He said nothing. world need you. If you quit, the ball biochemical laboratory. She took a long drag and exhaled the game is over. Think about it." • Utmost Convenience. Thanks to pick smoke slowly. "I didn't come here I guess I thought about it. up and delivery service, our product because of what you did for Mom. I Yesterday I was made associate comes when you need it.

recalled the night, about a year ago, professor in the English department • Economical. All this service, all this when Dad had his coronary. Fourin here at Smith College. I thought of protection against diaper rash costs the morning and you were waiting in you and knew you'd like to know.' far less than paper diapers — only the emergency room. "That's our A long overdue thanks. pennies more a day than home- doctor," said Mom. OUR DOCTOR. Affectionately, washed diapers. Those words. The subsiding fear as Barbara Colten Newburg CAUTION TO YOUR PATIENTS. It is illegal to you talked to us every 10 or 20 dispose ot human excrement in garbage minutes. He's in shock. It's touch and THE DOCTOR flipped off the light. Parents are doing this with paper/plaslic go. He's out of shock but the heart It was a good ending to a full day. He diapers. “Disposable" is a misnomer. rhythm is screwed up. His pressure is shared Barbara's letter with his wife at up and he has normal rhythm. The thesuppertable. Her eyes Baby cardiologist has arrived and says moistened. "How wonderful. How things look better. The intensive care absolutely wonderful. You steered Diaper unit and your talks to Mom and me in herwhen she needed steering. And Service the waiting room. The unhurried think of the ripple effect." TACOMA WATOLL FREE explanations. The hope and "The ripple effect?" queried 383-BABY 1-800-562-BABY optimism in your voice. Doctor. Dad's The Doctor. Washington's Oldest, Most Trusted recovery. That's why I came. There’s "Yes," his wife continued. -| Professional Diaper Service nothing wrong with me." "The students she will influence. And Serving Our Second Generation P“ She took a last puff and they, in turn, will influence their

1987 August The Bulletin 21 AMA Surveys of Physician and Public Opinion on Health Care Issues, 1987

The 1987 data reported here resulted from 1,000 telephone interviews with physicians who work in the United States.

1. Considering ail the problems and issues that presently confront healthcare in the United States, what is the main problem facing health care and medicine in the U.S. Today?

Physician Opinion 1981 1982 1983 1984 1986 1987 Cost-related 44% 58% 52% 50% 22% 26% ** Professional liability 2% 5% 34% 18% Government regulation 19% 10% 15% 19% 14% 13% Access/distribution 14% 4% 3% 4% 2% 5% Quality 2% 7% 5% 4% 7% 5% ** ** * Third-party reimbursement 7% * * ** Organization of medical care * 5% ***** Loss of physician autonomy 3% Other 17% 19% 20% 22% 7% 18%

In your community, are there too many doctors, too few doctors, or about the right numb*

Physician O pinion 1981 1982 1983 1984 1986 1987 About right 52% 49% 46% 50% 44% 52% Too Many 33% 41% 45% 43% 46% 39% Too Few 11% 6% 6% 5% 8% 6%

During the past few years, has your patient load been increasing, decreasing, or remaine

Physician Opinion 1982 1983 1986 1987 Decreasing 13% 15% 20% 17% Increasing 49% 44% 41% 37% Remained the same 29% 29% 31% 34% Unsure 9% 12% 8% 12%

Do you think you may consider practicing in an HMOin the future?

Physician Opinion 1981 1982 1983 1984 1986 1987 Already do/Yes 25% 24% 25% 33% 42% 37% No 69% 69% 65% 60% 53% 58% Unsure 6% 7% 10% 5% 5% 5%

5. Do you think you may practice within a Preferred Provider Organization or PPO, in the future?

Physician Opinion 1987 Already do/Yes 55% No 32% Unsure 13%

6. How serious do you feel AIDS is as a national health problem?

Physician Opinion 1987 Very serious 75% Somewhat serious 21% Not too serious 3% Not at all serious Unsure 1% 7. How much do you trust current scientific knowledge about how AIDS is transmitted? Physician Opinion 1987 A great deal 59% Somewhat 34% Not very much 6% Not at all 1% Unsure 1%

22 The Bulletin August 1987 Membership ------In accordance with the Bylaws of the Medical Society of Pierce County, ChapterSeven, Section A, MEMBERSHIP, the following physicians have applied for membership, and notice of their application is herewith presented. As outlined in the Bylaws, any member who has information of a derogatory nature concerning an applicant's moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of ihe Society.

Charles K. Bulley, Patrick J. Hogan, JohnS. Smoots, MD, Anesthesiology. III, D .O .,Born in MD, Internal Medicine. Born in Olympia, WA, Eveleth, Minn., Born in Phoenix,AZ, 12/15/57. Medical 6/18/51. Medical 5/27/58. Medical School, University of School, University for School, University of Washington, 1984; the Health Sciences, Arizona College of internship, Virginia Kansas City, 1977; Medicine, 1984; Mason Hospital, 6/84- internship, Madigan internship, Creighton 6/85; residency, Virginia Mason Hospital, Army Medical Center, 7/77-6/78; University, internal medicine, 7/85-6/87. 7/85-7/87. W ashington State License, residency, Letterman Army Medical Center, Washington State License, 1987. Dr. 1987. Neurology, 7/79-6/82. Washington State Smoots is currently practicing at 521 S. K License, 1978. Dr. Hogan is currently St., Tacoma. practicing at 1624 S. I St., Tacoma.

John S. Dimont, M a ry A . Lee, MD, W illiam S. Stovall, M D , Pediatrics. B orn in O b/G yn. Born in M D , O b/G yn. Born in Oxford, England Pueblo, CO, 1/2/44. Atlanta, GA, 7/14/54. 8/30/52. Medical Medical School, Medical School, School, Rush Medical UTHSC, 1983; Medical College of College, 1982; internship, John Sealy Georgia, 1980; internship,Oregon Hospital, Ob/Gyn, 6/83- internship, Madigan Health Sciences, 6/84; residency, John Army Medical Center, pediatrics, 6/82-6/83; residency, O regon Sealy Hospital, Ob/Gyn, 7/84-6/87. Ob/Gyn, 7/80-6/81; residency, Madigan Health Sciences, pediatrics, 6/83-6/85. Washington State License, 1987 Dr. Lee is Army Medical Center, Ob/Gyn, 7/81-6/84. Washington State License, 1987. Dr. currently practicing at 1624 S. I St. Tacoma. Washington State License, 1987. Dr. Dimant is currently practicing at 1811 S. K Stovall is currently practicing at 314 S K St., St. Tacoma. Tacom a.

Barbara J. Fox, MD, WSMA CONTRACT Dermatology. Born in Alton, ILL, 4/4/53. EVALUATION SERVICE Medical School, University of Cincinnati, What will the HMO or PPO do for you? 1979; internship, Madigan Army Medical What do they require of you? Center, pediatrics, 7/79- Will you assume a greater liability risk? 6/80; residency, Letterman Army Medical How will it affect your practice and referral patterns? Center, Dermatology, 7/80 - 6/83. Washington State License, 1980. Dr. Fox is currently practicing at 3908 10th St. SE, Find out before you sign. Puyallup.

The WSMA provides a free, objective, written analysis of an HMO Paul W. Hildebrand, or PPO contract to WSMA members. The analysis explains the pro­ MD, Emergency visions of the contract, points out areas that are vague, and suggest M edicine. Born in areas that should be clarified. The WSMA does not make a recom­ Ithaca, N ew Y ork, mendation regarding which contract you should sign. WSMA 5/27/41. Medical members desiring a written contract analysis should send a copy School, University of of the contract to:Medical Miami, 1968; internship, St. Mary's Hospital, 7/68- Washington State Medical Association 7/69. W ashington State License, 1985. 2033 Sixth Avenue, #900 Dr. Hildebrand is currently practicing at St. Seattle, WA 98121 Joseph Hospital Emergency Dept., Tacoma.

1987 August The Bulletin 23 Auxiliary in a Different Dimension By Alice Wilhyde, Pierce County Medical Society Auxiliary News Editor

Pierce County Medical Society Legislation and Membership. To be Mandatory Legislation, and Auxiliary earned national recognition selected from the many county Promotion of AIDS Education for with their successful 1986-87 projects of 50 states is quite an Youth. Organization resolutions membership phone-a-thon project. It accomplishment. (You'll be pleased involving restructuring of regions and was an honor to be selected as one of to know this reporter performed her attendance at leadership confluence eight program preview speakers and task in an entertaining and by state members-at-large did not have the opportunity to share our professional manner.) pass. The resolution to give the project information with over 300 Our phone-a-thon project is on AMAA immediate past president an representatives at the AMA Auxiliary file in the AMA Auxiliary Project Bank automatic seat on the Nominating House of Delegates in June. which is a clearinghouse of programs Committee was adopted. Arriving at Sea-Tac Airport in the developed by local auxiliaries around We heard state reports and early morning hours of June 20th with the country. Project Bank information learned Washington ranks with the traveling companions Sharon Ann is available to all auxiliary members on best in leadership, involvement in Lawson, WSMA Auxiliary President­ request. We have already shared our legislation, AMA-ERF, health and elect and Nancy English, WSMAA information with King County Medical membership programs. We elected Membership Chairman, I knew we Society Auxiliary and the Missouri an impressive, talented slate of were off to a great start when my State Medical Association Auxiliary; national officers, including our own hearing aids activated the security both were successful in increasing Mary Randolph of Olympia, as 1987- gate metal detector and I was asked to their membership. We gained 44 new 88 AMAA Treasurer. Special lunch identify a suspicious looking object in and reinstated members, an increase programs featured Mark Shields, my purse that turned out to be a small of 20%. nationally syndicated columnist and cassette of extra hearing aid batteries. The AMA Auxiliary House of political commentator and the Our non-stop flight arrived in Chicago Delegates officially opened Sunday delightful talk show hostess and without incident; our luggage didn't. afternoon in an impressive, colorful, actress, Oprah Winfrey. Don’t ask me how luggage can be lost moving ceremony that included the The inauguration of Betty on a non-stop flight. Our bags arrived roll call of the states and keynote Szewczyk, 1987-88 AMAA President three hours later, having chosen an address by former Secretary of was followed by a reception in her obviously different mode of Defense, Donald H. Rumsfeld. A honor. We were greeted by an Abe transportation. I was glad I was reception honoring Pat Durham, Lincoln look-alike from her home state carrying my talk and the phone-a-thon AMAA President and Betty of Illinois. material we were giving each State Szewczyk, AMAA President-elect The WSMA delegation hosted a delegation. followed. dinner at the Chicago Sheraton for This past year has been filled with In the action filled days that their auxiliary counterparts, and we many "firsts:” our phone-a-thon, my followed we had breakfast with were invited to attend the inaugural involvement in helping develop and AMPAC, a report on the vital role of ceremony and reception honoring organize such a comprehensive this important political arm of 1987-88 AMA President, William project, speaking to an audience of medicine. Francie Irwin, WSMAA Hotchkiss, MD. 300+ as a member of the Washington President, presented the official I had the opportunity to meet and delegation, and the very first mascot to Joseph Hatch, MD, AMPAC talk with auxiliary members from many time we've lost our State President Chairman. The new states and learned we share somewhere over Colorado on a mascot, AMiee, is a delightful concerns and involvement with the Spokane-Denver-Chicago flight. teddybear. The delegates adopted same basic health issues. I have Francie Irwin was "found" many hours seven health resolutions: Education gained a much better understanding later having survived thunderstorm on the Hazards of All Terrain Vehicles of the importance of the Federation. delays; her luggage never has been (ATVs), Support for Smoke-free We are auxiliary members working as a located. Health Care Facilities, Participation in team with our medical societies on The program preview session on the AMA Adolescent Health Initiative, county, state and national levels to Sunday morning featured two Child Water Safety, Prevention of improve the health and quality of life outstanding county projects in four Elder Abuse, Continuation of for all. Togetherwedom akea categories: AMA-ERF, Health, Seatbelt Education and Support of difference.

24 The Bulletin August 1987 Tacoma Visitor and Convention Our own Auxiliary has been well Bureau will be our speaker,telling us represented at the State level for Presidents about the many things going on in many years. This year is no Message Tacoma and special events coming exception. We have Cindy up in the future. Anderson, Vice President; Alice We are looking forwardto a busy Wilhyde, Pierce County Medical Many Auxiliary members are year that will include being actively Society Auxiliary News Editor; Alice already hard at work planning and involved with our Medical Society in Hilger, Organ Donations; Susie preparing for the coming year. What a the campaign to defeat Proposition Duffy, Nominating Committee; Cathy pleasure it is for me to have the 92. Wewillbethehostcountyfortwo Schneider, WAMPAC Auxiliary opportunity to work with members State meetings. WSMA/WSMAA will Representative. who give so generously and willingly meet in Tacoma Sept. 17-20. Our So as you can see, there are of (heir time and talents. own Dr. Ralph Johnson will be places to go and things to be done in A special thanks goes to Tim Horn installed as WSMA President. Auxiliarythisyear. Mary Lou Jones and St. Joseph Hospital for so Susie Duffy and Helen Whitney has put together a varied program generously letting us again use a are serving as co-chairpersons for the selection with the hope that you will room for our Board meetings this State Auxiliary functions at this find something of interest, of value or year. We greatly'appreciate their meeting. The WSMAA House of just pfain fun. So plan to join us for special hospitality. Delegates will meet in Tacoma, April what I hope will be a year of growing, Ourfirst general meeting will be 21-22,1988. OurownSharon Ann learning and fellowship. held Friday, Sept. 25, at the lakeside Lawson will be installed as WSMAA home of Dorothy Grenley. We look President. Bev Graham, President foiward to welcoming the Pierce County has every right to be PCMSA "Newcomers" in our medical proud of the outstanding community at this meeting, so it is a contributions of time and tafent these very special time of fun and two special people will bring to the See next page for listing of fellowship. Linda Olson from the State Association. president's committee chairpersons.

1987 August The Bulletin 25 P C M S A President announces committee chairpersons

As president ot the Pierce County Medical Society IMPAIRED PHYSICIAN Auxiliary Bev Graham has announced the following COMMITEE Marie Griffith committee chairpersons for her Board: 8606 Zircon SW Tacoma, WA 98498 TELEPHONE TREE Sharon Lawson 588-9371 2323 Crystal Springs Rd. W Tacoma, WA 98466 ADDRESS UPDATES Helen Whitney 564-6647 1736 Fairview Dr. S Tacoma, WA 98465 FINANCE Gloria Virak 564-4345 1319 Palm Dr. Tacoma, WA 98466 NEWCOMERS Terri Stewart 564-7503 2715 39th St. NW Gig Harbor, WA 98335 YWCA SUPPORT 851-5720 SHELTER Judy Brachvogel 1724 Fernside Dr., S. MAILING Mary Schaeferle Tacoma, WA 98465 521 Borough Rd. 564-4308 Tacoma, WA 98403 627-2716 HEALTH FAIR Sally Palm-Larson 7514 66th Ave. W PUBLIC RELATIONS Kit Larson T acoma, WA 98467 33 Lagoon Lane, N. SW 588-9839 Tacoma, WA 98498 584-3802 SCHOOL HEALTH Karen Benveniste 4622 Wayneworth W. TELEPHONE Mimi Jergens Tacoma, WA 98466 RESERVATIONS 565-3211 1702 Leonie Lane NW Gig Harbor, WA 98335 PULSE NEWSLETTER Marlene Arthur 851-5720 1205 21 st SW Puyallup, WA 98371 AMA-ERF Julia Mueller 845-5542 55 Summit Rd. Tacoma, WA 98406 BULLETIN Ginnie Miller 759-4862 4629 N. Mullen Tacoma, WA 98407 PHOTOGRAPHER Rubye Ward 759-7434 622 N. 4th St. Tacoma, WA 98403 LONG RANGE 272-2688 PLANNING Dorothy Grenley 40 Loch Lane SW PHON-A-THON Alice Wilhyde Tacoma, WA 98499 515 N. C St. 584-4421 Tacoma, WA 98403 572-6920 LEGISLATION JoAnn Johnson 7139 Interlaaken Dr. SW PHON-A-THON Betty Bahn Tacoma, WA 98499 624 Aurora N. 588-4168 Tacoma, WA 9806 572-6920 ORGAN DONOR Alice Hilger 954 Lynden Lane S. Tacoma, WA 98465 COOKBOOKS Shirley Kemman 564-2795 5228 126th Ave. Ct.E. Sumner, WA 98399 863-9152 ORGAN DONOR Maryln Baer 960 Altedena Tacoma, WA 98466 SUPPORT DottieTruckey 564-6374 634 Vista Dr. Tacoma, WA 98465 564-4886 26 The Bulletin August 1987 Auxiliary President's Committees continued from page 26

VOLUNTEER If you are an Auxiliary member and are interested in RESOURCES Debbie McAlexander working on any of these committees, please contact the 10230 Green Lane SW person in charge. If you know of a medical wife or family Tacoma, WA 98499 who is ill and needs some extra support, please contact 588-1013 Dottie Truckie. Any news item would be appreciated by Marlene Arthur, and Sally Larson is always interested in STUDENT volunteers for the Health Fair. Marie Griffith is quietly RECOGNITION Marge Ritchie available as the Auxiliary liaison with the Impaired Physician 4803 95th Ave. W. Committee. The Telephone Tree and Legislation always Tacoma, WA 98467 need volunteers, according to Sharon Lawson and 564-4112 JoAnne Johnson. These are just a few of the needs and aims of Auxiliary, and your assistance is necessary for you MSPC HOLIDAY to achieve our goals. dinner Sharon Lukens If you are not a member of Auxiliary, perhaps this 2808 East Bay Dr. NW listing will spark your interest in joining. In helping the Gig Harbor, WA 98335 medical community, we are also helping the community in 858-3725 which we live. This can best be accomplished by our working together. Membership is just a telephone call CHILDREN'S HOLIDAY away, 839-9366, and Candy Rao will help to tell you about PARTY Kim Nelson the Pierce County Medical Society Auxiliary. 5613 70th Ave. W Tacoma, WA 98466 565-8117

FUNDRAISER Susie Duffy 1722 Voight Ave. Sumner, WA 98390 863-4314

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1987 August The Bulletin 27 705 South Ninth Street Suite 203 Tacoma, Washington Telephone 12061 572-3(i

DATE: Tuesday, September 8,1987 TIME: 6:00 p.m. No host cocktails 6:45 p.m. Dinner 7:45 Program

PLACE: Fircrest Golf Club 6520 Regents Boulevard COST: Dinner $13.50 per person

Four at-Large members of the MSPC Nominating Committee will be elected at the meeting.

Register now. Please complete the attached reservation form and return it, with a check for the appropriate amount made payable to the Medical Society of Pierce County, in the enclosedpre-addressed envelope, or call the Medical Society office 572-3667, to confirm your attendance. Reservations must be made no later than Friday, September 4.

REGISTRATION:

Yes, I(we) have set aside the evening of September 8 to join my fellow Society members for the presentation on Initiative 92.

Please reserve. _dinner(s) at $13.50 per person (tax and gratuity included)

_I w ill attend the program portion only o f the meeting

Dr.

RETURN TO MSPC BY NO LATER THAN SEPTEMBER 4

28 The Bulletin August 1987 For Medication Given at School

PHYSICIAN ORDER FORM APPROVED

Recent changes in state law perm it the giving of oral medication to students during school hours provided proper authorization from physicians and parents is obtained. Use of a standardized county-vide form has been suggested Isee The Bulletin, "Public Health/School Health Report," November, 1982). The Public Health/School Health Committee has approved the following form for physician use. The form is publish­ ed in this issue for the convenience of physicians. Please have your office staff reproduce the form as needed — Tke E ditor Medical Society of Pierce County Physician’s Orders for Medication at School

Medication is ordered to be given to a student at school only when absolutely necessary. W henever possible, the parent and physician are urged to design a schedule for giving medication outside of school hours. If this is not possible, it must be understood by the parent that the medication will be dispensed by the principal or his/her designee in the absence of the school nurse. Only prescription oral medication will be administered. The principal will designate the person responsible to dispense medication on an individual basis. The school accepts no responsibility for untoward reactions when the medication is dispensed in accordance with the physician's directions.

Is it necessary to dispense this medication during school hours? ______Y e s N o

If yes, please give diagnosis or reason: ______

Name of p atien t: ______

Drug and dosage form: ______

Dose and mode of administration: ______

Houris) to be given:______

Duration without subsequent order: ______

Side effects of drug (if any) to be expected: ______

D ate:______Physician’s signature:

Parent’s Permission

I request that the principal or a staff member designated by him/her be permitted to dispense to my child, (name of child)

______the medication prescribed by (name of physician)

______for a period from ______t o ------■

The medication is to be furnished by me in the original container labeled by the pharmacy or physician with the name of the medicine, the amount to be taken, and the tim e of day to be taken. The physician’s name is on the label. I understand that my signature indicates my understanding that the school accepts no liability for untoward reactions when the medication is administered in accordance with the physician’s directions. This authorization is good for the current school year only. In case of necessity the school district may discontinue adm inistration of the medication with proper advance notice. If notified by school personnel that medication remains after the course of treatment, I will collect the medication from the school or understand that it will be destroyed. I am the parent or the legal guardian of the child named.

D ate:______Signature of parent or guardian: ______

Student’s home address: .School: TIM E OF EXAM INATION: For athletics, during the 12-month period prior to first participation in interscholastic athletics in middle school or junior high school, and prior to participation in high school. Clearance for continued participation is to be provided on this form prior to each subsequent year of interscholastic athletics. A yearly clearance from the examiner is needed for continued participation. CHOICE OF EXAM INER: It is recommended that each child have a personal physician knowledgeable regarding each aspect of his/her health. Examination may be performed by a licensed physician (M.D. or D.O.), a licensed physician's assistant, or a certificated pediatric or family nurse practitioner working under the direction of a physician whose name is to be stated. THIS SECTION IS TO BE COMPLETED BY THE PARENT OR GUARDIAN BEFORE EXAMINATION BY THE PHYSICIAN, PLEASE PRINT.______L a s t N am e F ir s t Middle Birthdate: Month/Day/Year Sex: F or M Name of School, Camp or Organization

Name of Parent of Guardian Address Zip Home Phone Work Phone

Usual Physician or Source of Health Care Phone Dentist Phone

CIRCLE PURPOSE(S) OF REPORT: SCHOOL:-Preschool. Kindergarten, Elementary School, Junior High, High School. To enter grade ______S ep tem b er 19. INTERSCHOLASTIC ATHLETICS: baseball, basketball, cross country, football,gymnastics, soccer, swimming, tennis, track, volleyball, wrestling. OTHER: day care, developmental center, child study, park board recreation, boys club, camp, lifesaving, other (sp e cify ) ______IS THERE ANY ILLNESS OR HANDICAP, or other situation which might affect performance? (Please explain)

CHILD HAS OR HAD THE FOLLOWING: Circle the appropriate item(s), and explain on the right. Name other doctors important in child’s care. SKIN: acne, eczema ORTHOPEDIC: fracture or sprain, scoliosis, congenital hip VISION: glasses, contacts NEUROLOGICAL: convulsions, meningitis, cerebral palsy HEARING: aids METABOLIC: diabetes NOSE: bleeding BLOOD: anemia, sickle cell disease MOUTH: dental decay, orthodontia ALLERGIES: food, insect, pollen, contact, drugs, LUNGS: asthma, bronchitis other, (specify)______HEART: congenital, rheumatic H O S P IT A L IZ A T IO N (S ): (Y e ar & R e a s o n )______GASTROINTESTINAL: ulcer, colitis, hepatitis OPERATION(S): (Year & Reason) ______GENITOURINARY: kidney or bladder infection HANDICAP: physical, mental, behavioral, social, Menstruating, if female: Yes ( ) No( ) learning, vision, hearing, speech, hyperkinesis H a s ch ild had : rub eo la ( ), ru b e lla ( ), m um ps ( ), c h ic k e n pox ( ), w h o o p ing cou gh { ) If child under 3 years give birthweight ______Describe unusual factors regarding birth or health immediately after birth _

Doses Received M o nth/Year of IMMUNIZATIONS None Immunizations 1 5 or m ore Last Immunization Diphtheria. Tetanus, Pertussis DTP, DT, Td Any combination of DTP/DT/Td (circle dose given) Oral Polio Vaccine (OPV) OPV Rubeola (7 day or hard measles) Immunization report need not Rubeola be completed if a separate im­ Rubella (3 day. mild or German measles) Rubella munization certificate is being M um ps submitted at the same time. Mumps I certify that to the best of my knowledge the information given above is Date Signature: Parent or Guardian accurate and the immunizahons checked have been received. THIS SECTION IS THE RESPONSIBILITY OF THE PHYSICIAN. PARENT(S) SHOULD BE PRESENT FOR EXAMINATION.

Date of examination Height Weight Blood pressure Hearing: Right Left Hematocrit Sickle H em oglobin Urinalysis C e ll

Vision: Right Left Vision corrected: Right Left Color Vision Tuberculosis skin test: Date Type Result 20/ 20/ g la s s e s , c o n ta c ts 20/ 20/ (circle which) CIRCLE ABNORMAL AREAS. DISCUSS AT RIGHT Appearance Scalp Throal Neurological Development Head Chest Dental Nutrition Eyes Lungs Genitalia Acne Ears Heart Extremities Rashes Nose Abdomen Back (Shows no evidence of Kyphosis or Scoliosis) An additional narrative report is attached or will be forwarded. Yes { ) No ( ) INTERVAL NOTE: Identify any occurences since examination which could effect participation in school, athletics, or other activites.

REFERRAL(S) (Circle) Eye. Ear, Dental, Orthopedic. Other (describe)______Parents need help to obtain Yes ( )No( ) Please name other doctors involved in care of child:

ASSESSM ENTS THAT MAY BE NEEDED IN SCHOOL OR OTHER FACILITY: Hearing, Speech, Psychology, Occupational therapy, Physical therapy, Guidance, Learning. If you believe child should be considered for special education, please describe need above.

^DICATlONS^QuTREDTO~BE"GiVE"N7NSCHOOLORbTHER~FAClLlTY. Diagnosis"." ~ ~ Name of medication Form D o se T im e Duration of prescription Possible effects

RECOMMENDED PHYSICAL ACTIVITY: Full day care, preschool, school, physical education, sports or camp activity. .. Swimming Modified or restricted activity (describe). , Interscholastic athletics. If wrestling, not to go below what weight? lb. A physician s written release is required to resume participation following all illness and/or injury serious enough to require medical care. Give details above. Date signed Next recommended date of examinalion Physician’s Name (Please print) Signature and Title

Prepared by the Medical Society of Pierce County m cooperation with Tacoma and Pierce County preschools and schools^Tacoma-Pierce County Health Depart ment, Department of Social and Health Services, child care, youth and camping organizations. Printed through courtesy of Tacoma School District.

TPS • 25 - 7/79 Revised 9/81 Original - parent or auardian: C odv • o hvsician or health source Classifieds surgery is preferred. A creative mind and Positions Available active participation in local, state or national Equipment professional activities a plus. Confidential responses to John Almond; Almond & Pacific Northwest opportunities. We have For Sale: Motorola-MT500 2 way pager Rogers Inc.,1101 Fawcett, Suite 305, openings in the northwest and California. with case and charger and new battery. Tacoma 98402. Phone 572-0300. $750.00. Phone 572-5025 or 572-5031 Let us assist you. Send C .V. or call Western States Physician Services, 9605 and ask for Sharon. Sunrise Beach Drive NW, Gig Harbor, WA 98335 (206)851-6201.

Immediate openings. Full tim e and Part Office Space time, positions and directorship in T a com a acute illness clinic. H ourly rates plus Professional office space 3 blocks from Practices Available excellent malpractice. Flexible scheduling. Allenmore Medical Dental Building. Any state license. O th er opportunities Approximately 1,100 sq. ft. remaining. including ER in O lym pia area. Call N ES 1 - Generous leasehold improvements $11 Family Practice - Excellent opportunity with 800-554-4405 ask for Ginger. per sq. ft., 752-6622. Seattle’s leading provider of Family Practice. Positions available thru out Full time position available for general greater Seattle. Current license BC/BE in practice MD in Gig H arbor clinic, affiliated family practice. Attractive salary incentive/ with G.H. physicians. N eeded by Aug. benefits. Contact CHEC Medical 2200 6th 1987. Contact Jam es Patterson, M D (206) General Ave. #225, Seattle, WA 98121, Debbie 851-5121. Phillips (206) 728-6888

WESTERN CLINIC, a large multispecialty Norman Rockwell lithograph clinic, is seeking physicians fo r the "DISCOVERY" AKA "BOTTOM DRAWER" following positions: Fam ily Practice at Port artist proof, small edition. Call 584-6935. Clinic Facility - No night or w eekends; no OB. General Internal Medicine - at Tacoma r facility. Ob-Gvn - for both Tacom a and G ig Harbor facilities. Family Practice w ith O B - at Tacoma facility. All positions offer excellent Advertising in the classifieds starting salary, fringe benefits, and is one of the best ways to reach partnership potential. C ontact W illiam Brand, MD c/o The W estern C linic, 521 the medical community... South "K" St., Tacom a, W A 98405, 206- 627-9151. To place your classified advertisement call the Medical Society Office, 572-3709 or fill out the Positions available - inpatient psychiatrists. form below and mail to: Fee for service. Hospital will handle billing and collection. Possibility of development Medical Society Office, of outpatient practice. Weekend Membership Benefits, psychiatrist 8:00 a.m Sat. to 8:00 p.m . 705 South 9th, Suite 303 Sun. Salary and benefits competitive. Tacoma, WA98405. Contact John E. Kooiker, M D, M edical Director Psychiatry unit, St. P eter Classified rate is .85 per word, 10 word miniumum. Hospital 413 N. Lilly Rd., O lym pia W A Enclose check made payable to Membership Benefits, Inc. 98506 206-456-7060. 1

Physician opening. A m bulatory care/m inor Name______I emergency center. Full/part tim e for I FP/IM/EM trained, experienced physician. Address------P h o n e ------1 Located in Tacom a area. Flexible I scheduling, pleasant setting, quality City------S ta te ------g medicine. Contact D avid R. Kennel, MD at 5900 100th St. Southwest, Suite #31, I Tacoma, W A 98499. P hone (206) 584- Copy for Classified A D ______I 3023 or 582-2542. ______I Medical Director. Join P ierce C ounty I Medical Bureau's progressive m anagem ent 1 team in developing innovative new programs in physician sponsored financing. i Qualified physician experienced in 8 utilization review, quality assurance and ______I physician reim bursem ent concepts. Board Certified in prim ary care specialty o r general L 1987 August The Bulletin 31 V

Now Available The Health Policy Agenda for the American People

A Comprehensive A Fleaith Policy O rd e r N ow Framework for the Future Partnership To order your copies of the HPA After five years of collaborative effort. Representatives of the health profes­ Summary and Final Reports call The Health Policy Agenda for the sions. insurers, health care institutions, toll-free 1-800-621-8335. In Illinois American People (HPA) has issued its consumer organizations, business call collect 312/645-4987. Or Summary and Final Reports recom­ groups and the government collabo­ complete and mail the form below mending policy guidelines for the future rated to develop recommendations that with your payment to: of our health care system. This land­ reflect this broad array of viewpoints. The Health Policy Agenda for the mark effort establishes a com prehen­ Learn what the HPA has recommended American People sive. long-term framework for U.S. on vour behalf... and how it will affect P.O. Box 10946 health policy inio the 21st century. vour future. Chicago. Illinois 60610-0t)4fi O rder No. OP-2G7 Broad Reaching Recommendations O rd e r Form The HPA Reports contain guiding Please send me copies of Subtotal

principles and specific policy recom­ the HPA Summ ary and Final Reports Sales tax 1 1L, NY residents) mendations covering a wide subject (OP-207 1 ;n S35> for the two volume set. Total area: ■ supplying. distributing and educating health professionals \ , m- ■ providing technology and facilities

■ organizing resources A il. lr r s s ■ communicating health information ■ ensuring quality ■ paving for services ■ preparing for the future through < S lilli* 7 1|. research Please charge my: 'J VISA r] MASTERCARD

< Rilil < niil Number Expir.ilu>n !Jjlc

S nin.nu"; PlionL-

Payment must accompany order. Please allow 4-6 weeks for delivery. For information on bulk purchases, please call 312/280-7168. NOWTG. HAS TWICE THESUCE OF LIFE. Tacoma General Hospital now has two CT scan' ners and a new laser imager. To give you even sharper photographic images. And the most advanced diag- nostic capabilities available. Well even schedule your patients during the evening hours by appointment. When you admit to Tacoma General, expect the most modern facilities and the best trained personnel. Plus a health care environment where quality technol­ ogy and human touch are synergistic. aa MultiCare Medical Center Medical excellence from MultiCare <

PHYSICIANS

Your Army Reserve Personnel Counselor would like to talk to voii a b o u t th e follow in g opportunities in the US Army Medical Department:

PART-TIME INCOME CONTINUING MEDICAL EDUCATION RETIREMENT POTENTIAL ATTENDANCE AT AMA CONFERENCES POST EXCHANGE PRIVILEGES TRAINING AT U.S. ARMY HOSPITALS INSURANCE DISCOUNTS ALL PAID FOR BY THE US ARMY RESERVE

Major Paul H. Lawhon, MSC 206-967-5046

USAR AMEDD Procurement, P.O. Box 38. Madigan Army Medical Center, Tacoma, WA 98431-5038 Many groups TALK about building a better America- The Army Reserve WORKS at It.

Tel-Med A Library of Free Recorded Health Tips. • Over 200 topics, from tonsillectomy to osteoporosis, researched and written by physicians. • Brochures listing these topics are free to you and your patients. If you would like a supply for your waiting room, please call 597-6655.

A Community Service Sponsored By: Pierce County Medical A Blue Shield Plan

1) 1-1 Hroadway Plaza Tacuma, WA 98402 C onsider the causative organism s...

cefaclor 250-mg Pulvules t.i.d. offers effectiveness against the major causes of bacterial bronchitis Haemophilus influenzae, Streptococcus pneumoniae (ampicillirvsusceptible and ampicillin-fesisfant) Note: Ceclor is contraindicated in patients with known Penicillin is the usual drug of choice in the treatment and allergy to the cephalosporins and should be given cau­ prevention of streptococcal infections, including the pro­ tiously to penicillin-allergic patients. phylaxis of rheumatic fever. See prescribing information.

C e c lo r' (cefaclor) Precautions: • Symptoms of pseudomembranous colitis may • Other eosmoptiilia. 2 V genital pruritus or vagi­ • Discontinue Ceclor in ihe event of aileroic reac­ appear either during or after antibiotic treatment nitis. less ttian IV and, rarely, throm­ Summary. Consult Ihe package literature far tions lo it. • H ypersensitivity react Ions (including mor­ bocytopenia. prescribing Information. • Prolonged use may result in overgrowth Ol ion- billiform eruptions, prorilus, urticaria, and Abnormalities In laboratory results ol susceptible organisms serum-sickness-like reactions that have included uncertain ellology Indications: Lower respiratory infections, includ­ erythema muHiforme (rarely. Slevens-Johnson • Positive direct Coombs' tests have been • Slight elevations m hepatic enzymes ing pneumonia, caused by susceptible strains of syndromcl dr the above skin manifestations reported during treatment with cephalosporins • Transienl fluctuations m leukocyte count (espe­ Sfrep/ococcus pneumonise, Haemophilus inllu- accompanied by arthnti^arlhralgia and fre­ cially in infants and children) e/i/ae, and Streptococcus pyogenes (group A • Ceclor should be administered with caution in quently, fever): 1.5%: usually subside within a lew 0-hemolytic streptococci). the presence dI markedly impaired renal function days alter eessalion of therapy. Serum-sickness­ • Abnormal urinalysis, elevations m BUN or serum Although dosage adjustments in moderate to like reactions have been reported more frequently creatinine. Contraindication: severe renal impairment are usually not required, In children lhan in aduils and have usually • Positive direct Coombs' test Known allergy to cephalosporins careful clinical observation and laboratory stud­ occurred during or following a second course ol • False-posilive tests lor urinary glucose with ies should be made therapy with Ceclor Ho serious sequelae have Benedict s ot FeMng s solution and Contest’ tab­ Warnings: • Broad-spectrum antibiotics should be pre­ been reported Antihistamines and corticoster­ CECLOR SHQULO 8E AOMINISTEREO CAUTIOUSLY lets but not with Tes-Tape’ (glucose enzymatic scribed with caution in individuals wiih a history oids appear to enhance resolution ol the syn­ test strip, Lillyi TO PENICILLIN-SENSITIVE PATIENTS PENICILLINS ol gastrointestinal disease, particularly colitis drome lorjaaofti ANO CEPHALOSPORINS SHOW PARTIAL CROSS- • Salely and effectiveness have not been deier- • Cases ol anaphylaxis have been reported, hall at pa, am p ALLERGENICITY POSSIBLE REACTIONS INCLUDE minad in pregnancy, lactation, and infants less ANAPHYLAXIS which have occurred in patients wiih a history ol than one month old Ceclor penetrales mother's penicillin allergy. Administer cautiously lo allergic patients [LI LILl'V ANLi COMP-'Ui' milk Exercise caution in prescribing for these • As wilh some penicillins and some other cepha­ Pseudomembranous colitis has been reported patients with virtually all broad-spectrum antibiotics It losporins. transient hepatitis and cholestatic :aun- must be considered In differential diagnosis ol Adverse Reactions: (percentage of patients) dice have been reported rarely antibiotic-associated diarrhea. Colon 1iora is Therapy-related adverse reactions are uncom­ • Rarely, reversible hyperactivity, nervousness, mon. Those reported Include: altered by broad-spectrum antibiotic treatment, Insomnia, confusion, hypertonia, dizziness, and Eli Lilly Industries Inc possibly resulting In antibiotic-associated colitis. • Gastrointestinal (mostly diarrhea): 2.5%. somnolence have been reported. Carolina, Pul-i t> Ri. .■ ri'>-r MEDICAL SOCIETY OF PIERCE COUNTY 705 S outh 9 th , Suite 203 BULK RATE Tacoma, Washington 98405 U.S. postage PAID ADDRESS CORRECTION REQUESTED I TAC0MA WASH

PERM IT NO. 605 M S r t A' T

" 1 ' i t # km r: d- publication "of the Jvledical 'Society of Pierce County

VOL. 2, NO. 6 705 South 9th, Suite 203 SEPTEMBER, 1987 Tacoma, Washington 572 - 3 6 6 7

INITIATIVE 92 STOP 92 packet you have SEPTEMBER GENERAL MEMBERSHIP received from WSMA for MEETING Official Ballot Title: talking points on the issue. Plan on attending Initiative 92...How will it Shall it be a consumer the September General impact you? A pane], of protection violation for Membership Meeting on WSMA leadership will doctors treating Medicare September 8. discuss this ballot issue eligible patients to charge and the strategies planned more than Medicare’s MSPC and WSMA have bro­ to achieve victory on this i reasonable charges? chures on Medicare, an major issue at the Septem­ educational insert on ber 8 General Membership Official Summary of Initia­ Initiative 92, a poster for Meeting. tive 92 your waiting room to promote discussion between WSMA President-Elect, Dr. you and your patients, Ralph Johnson; Tom Curry, This initiative declares as stickers and a fact sheet WSMA Executive Director and an unfair and deceptive on the initiative for your J. Michael Ryherd, "No on practice under the Consumer stationery. Call the 92" campaign manager will Protection Act a medical office today. present an educational doctor, osteopath, chiro­ forum on this critical practor, podiatrist, The Medical Society has a issue. dentist or optometrist: (1) core of speakers who are charging or trying to well informed on the Fircrest Go.lf Club will be collect for medical Initiative. If you belong the site of the meeting services to a Medicare to a fraternal or community with social hour beginning eligible patient more than organization that has a at 6:00 p.m,; dinner, 6:45 Medicare’s determination of program chairman, a speaker and program at 7:45. a reasonable charge, and (2 can be arranged and failing to enroll as a scheduled for your club. participating physician in It needs to be done now. ABSENTEE BALLOTS Medicare if treating Medicare eligible patients An Absentee Ballot Request other than solely in was sent to each member emergency situations. with the September General Sanctions include civil Membership flyer. If you fines, damages, and WSMA have difficulty making it \ injunctive relief. to the voting booth, Annual submit the request to the It is essential that your County Auditor’s office as patients and the general indicated. Each vote public be informed how Meeting counts. If you need Initiative 92 will impact another, please call the . them. Please review the SEPTEMBER 17-20 Society office. Tacoma Sheraton MSPC NEWSLETTER SEPTEMBER CLASSIFIED ADS

P O S I T I O N S AVAILABLE

Pacific N.W. opportunities. We have openings in the N.W. and California. Let us assist you. Send C.V. or call Western States Physician Services, 9605 Sunrise Beach Dr. N.W., Gig Harbor 98335 (206) 851-6201.

Physician opening. Ambulatory care/minor emergency center. Full/part time for FP/IM/EM trained, experienced physician. Located in Tacoma area. Flexible scheduling, pleasant setting, quality medicine. Contact David R. Kennel, M.D. at 5900 100th St. S.W. Suite 31, Tacoma 98499. Phone (206) 584-3023 or 582-2542.

Immediate opening - full time & part time positions and director­ ship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice. Flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1-800-554- 4405 ask for Lois.

MEDICAL EQUIPMENT

Burdick ECG machine and stand $1474.00. 24 test isocult in­ cubator $62.50. Ultraviolet examining light $49.00. Evenings 588-7545, days Dr. Boyle 582-8440.

Merlin telephones, model 206. Standard 5 button set with control unit. $950.00. Call between 9:30 and 5:00 p.m. 564-9074.

PRACTICES AVAILABLE

WESTERN CLINIC, a large multispecialty clinic, is seeking physicians for the following positions: Family Practice at Port Clinic Facility - No nights or weekends; no OB. General Internal Medicine - at Tacoma Facility. Ob-Gyn - for both Tacoma and Gig Harbor facilities. Family Practice with OB - at Tacoma facility. All positions offer excellent starting salary, fringe benefits, and partnership potential. Contact William Brand, M.D., c/o The Western Clinic, 521 South K Street, Tacoma WA 98405, 206-627-9151.

Full time position available for general practice M.D. in Gig Harbor clinic, affiliated with G.H. physicians, needed immediate­ ly. Contact James Patterson, M.D. (206) 851-5121.

FOR SALE

BOSTON WHALER SAILBOAT, Harpoon 5.2 w/trailer, $3,995.00. 4HP Evenrude motor, $795.00. John Chester, (503) 399-9129.

MSPC NEWSLETTER 2 SEPTEMBER, 1987 WSMA ANNUAL MEETING MSPC' r e p r e s e n ta tiv e s on th e RETIRED MEMBER LUNCHEON SHERATON-TACOMA WSMA Board of Trustees and September 17-20 serving as delegates will "U.S.S.R. and One" is the title of Dr. Kenneth Gross’ b e : MSPC1 w ill be well repre­ talk scheduled for the sented a t th e WSMA House; o f Ralph A. Johnson, WSMA. Retired Member Luncheon on Delegates meeting in Pres i de n t - F1ee t September 8. Dr. Gross Tacoma, September 17-20. Richard Hawkins, Vice will talk about his trip to Speaker Russia which included president Dick Bowe w ill Robert G. Scherz, WSMA visit? to hospitals and oil'cr medical facilities. lead the following who w ill T ru s l e e serve as delegates and Charles M. Weatherby, alternate delegates: WSMA T ru stee The meeting will be held at the Tacoma Dome Hotel, OKI .KGATES MSPC members represent ing 12:00 noon, Wednesday, other organizations as September 8. Registra­ Richard G. Bowe, P res d e le g a te s : tions should be sent or1 William B. Jackson, P res called in by September 4 to Elect Richard A. Hoffmejster, the Medical Society office. Kenton C. Bodily, Vice Pres Wash i.ngton Orthopaedic Robert B. Whitney, Sec-Treas Association Gerald W. Anderson, Trustee W illi run G. Ma rsh , WSMA/- If you have retired, bring Johann D uenhoelter, T ru stee Hospital Medical Staff your spouse and join your Michael L. H alstead , T ru ste e S ect ion colleagues for an enjoyable Ronald W. K night, T ru stee Richard Vimont, Senior lunch and company. Peter K. Marsh, Trustee Physicians of Washington Paul D. Schneider, Trustee Eileen R. Toth, T ru stee Dr. Bowe will be serving a= DOCTOR/LAWYER/DENTIST Chairman of the committee FIELD DAY ALTERNATE DELEGATES t.o s e le c t the m eeting s i t e o f th e 1991 WSMA Annual A full day of activities is Leonard B. A lenick Meeting and Dr. Peter Mars!, Charles L. Anderson planned for the Doctor/ will chair Reference Lawyer/Dentist Field Day Thomas H. C lark Committee B. Dr. Hawkins, David S. Hopkins sehedu1ed f o c F r jd a y , Vice Speaker will be September 25. James D. K tue^er alternating with Dr. David DeMaurico Moses Will ianis , Speaker, in G i. 1 bei't J . Ro 11 a r The Field Day will consist G. Bruce Smith chairing the proceedings of of three activities: golf, George Tanbara the House of E>elegates. tennis, and a running event Stanley W. Tuell (5-mile). A prime rib Surinderjit Singh dinner with awards cere­ monies taking place at the Tacoma Golf & Country Club at. the conclusion of the WSMA Annual Meeting event s .

SEPTEMBER 17-20 For more informat ion, please rail the Medical Tacoma Sheraton Society office at 572- 3667 .

ADVERTISING AND NEWSLETTER COPY MUST ARRIVE IN THE SOCIETY' OFFICE BY THE 15TH DAY OF THE MONTH PRECEDING THE PUBLICATION DATE. ADVERTISEMENTS IN THIS NEWSLETTER ARE PAID AND NOT NECESSARILY ENDORSEMENTS OF SERVICES OR PRODUCTS.

MSPC NEWSLETTER 3 SEPTEMBER, 19 87 Continued from Rage 2

Family Practice - Excellent opportunity with Seattle’s leading provider of Family Practice. Positions available thru out greater Seattle. Current license BC/BE in family practice. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Ave. #225, Seattle 98121, Debbie Phillips (206) 728-6888.

Clinic and active Family Practice for sale in Puyallup - Contact: ’’PRACTICE” 10215 12th Ave. S., Tacoma 98444.

GENERAL

New catalog. Over 500 items available at tremendous savings. Call Lynlee’s (206) 453-8892 for free copy.

SE RE’CO Associates specialists in crisis situations in office management and bookkeeping. Available for new office set-up. Call 927-6540.

FOR SALE ELEGANT, PANORAMIC VIEW HOME in a professional neighbor­ hood in the Narrows/St. Charles area. This home features quality in every area from the formal living and dining rooms with full marine and mountain views to the expansive master suite, to the luxurious, fully equipped birch kitchen. The unique entertain­ ment areas are highlighted by a fireplace conversation pit and library. The home is perfect for entertaining and for a large family with more than 4,200 sq. ft., 6 bedrooms and 3 baths. It has an attractive brick front and features 1/2 acre beautifully landscaped grounds with 2 private patio yards. There is much more Further reduced $14,000 the home is now offered for sale at $174,500. Please call RON WILLIAMS for further informa­ tion or a private showing. #46014. 752-6696 (ofc) or 752-7069 (Evenings). W.H. OPIE & Co.

OFFICE SPACE

Professional office space 3 blocks from Allenmore Medical Dental Building. Approximately 1200 square feet remaining. Generous leasehold improvements. $11 per square foot. 752-6622.

ARE YOU AVAILABLE FOR LOCUM TENENS? If so, please contact the Society office, 572-3667.

no YOU MAKE HOUSE CALLS? If so, please contact the Society office at 572-3667. WAMPAC

MSPC NEWSLETTER 4 SEPTEMBER, 1987 MSPC Speakers Bureau SEPTEMBER MEETING SCHEDULE i Many members of the Society September ; volunteer their time and 1 ... Board of Trustees expertise to speak before 3 ... "Project Access" groups who have requested a 4 ... Committee on Aging speaker from the Medical 8 ... General Membership Society. The following Meeting - Fircrest members graciously volun­ Golf Club teered : 9 ... Credentials Robert G. Scherz, M.D. Committee Rainier Chapter, Am Assn. 9 ... Retired Member of Medical Transcrip- Luncheon - Tacoma tionists Dome Hotel 10 ... MBI Board of During rhe posr 10 years rare coins hove ourpoced oil, gold, silver, Michael R. Lovy, M.D. - Directors diamonds, even real esrore, os o Am. Assn. of Retired 10 ... WSMA Delegate superior invesrmenr . averaging Persons, Chapter #27 Caucus over 20% annual appreciarioa 14 ... Medical-Legal If you'd like more mformarion Committee regarding building your own, personal rare coin portfolio please give me a Paul D. Schneider, M.D. - 15 ... Executive Committee call. Pierce College Nursing Stu­ 16 ... Public Health/ Here or HRCI we guaronree whor dents School Health Committee we sell, and, wherher you're a new 17 ... House of Delegates invesror or o seasoned professional we offer: Thomas M . Herron, M.D. - convenes - Sheraton Hotel M INSTANT LIQUIDITY . . . Published Gig Harbor Rotary bids rhar give PCGS cosh values 18 ... WSMA Reference ar any rime. Juan F. Cordova, M.D. - Committees m LIFETIME GUARANTY o f coin Rainier Chapter, Am. Assn. 19 ... MSPC Delegate Caucus authenticity (Breakfast) H GUARANTEED REPURCHASE of Medical Transcription- agreements ists 20 ... MSPC Delegate Caucus (Breakfast) H COMMISSION FREE counseling and sales service 21 ... Dr. S . Havsy vs. HI UPDATED statements o f value MSPC trial commences ■ PEACE OF MIND . . . Wirh guar­ 23 ... AIDS Committee anteed PCGS coin grading 23 ... MSPC Computer User H A 15-day rerurn privilege Group If you're a collector or on investor. . .HRO Dr. Roy H. Virak Assumes 24 ... EMS Committee wanrs ro work wirh you to build a profitable Chairmanship at PCMB 24 ... "Better Dental portfolio. Health" Committee Dr. Roy Virak, MSPC member 25 ... Field Day ! Rare Coin Investments, Inc. since 1961 assumed the 28 ... Continuing Medical Chairmanship of Pierce Education Comm. ^Pleose send m e more rare com information County Medical Bureau’s Nome Board of Trustees in May. Address Dr. John H. McGowen was selected as Chairman- Elect. Phone

The Bureau is celebrating its 70th Anniversary. It ■ , . :}3n.DOCK STffEET SUITE 204 ■ ' . . TACOMA. v/A :-8403 '■ was founded on June 17, (206) 627-2883 or 1-800-826-0039 1917 by 11 physicians. Today, Pierce County A BONDED. LICENSED PROFESSIONAL Medical covers over 1800 groups and has over 1,000 Participating Providers.

MSPC NEWSLETTER SEPTEMBER, 1987 WELCOME BACK heaved a sigh of relief and deployed; there was an EMT DR. POMEROY! avoided the next patch of in each of the four gravel with a smooth flick support vans, and each van of the bars. Just another had three radios. A Climbing hills on a bicycle slice of adventure in the "base-support" ham radio life of a "Trekker". is hot work in Pennsylvania operator was designated TransAm Trekker that in July, with humidity each day in the area of is. A participant in the about 85% sind the tempera­ our travel. The vans, ture above 90. The county TransAmerica Bicycle Trek, midway checkpoint, gear roads go straight up, steep a fund-raising event truck, and base support pitches sometimes half a sponsored by and for the were in constant contact. benefit of the American Every Trekker had the mile. I was glad the climb Lung Association. Seattle up "the ridge" on US 40 had phone number of the base to cater to trucks too; it to Atlantic City, 46 days, support so Trek staff 3400 miles, with 196 riders wasn’t so steep. But it support was always easy to and 25 support staff. was 3 miles long...and the reach. Breakfast and dinner Emergencies did sign for trucks descending said ”10% grade”, so it was provided, lodging (tent, occur, as one might expect steep enough. Once at the dorm room, or (rarely) a over the course of 686,000 motel) arranged, overnight trekker-miles. Bicycle- top, at a well-earned water gear transported. Just pay break, I thought of how far auto encounters happened I had come to get here. $100. to register, raise relatively rarely until $5000 minimum in pledges 3200 miles give or take a Pennsylvania: 3 from few, and I was in better for the ALA, and you're Seattle through Ohio, and shape than I had every off. Piece of cake, right? 6 in Pennsylvania. Well, not exactly but close dreamed. Sure, I still Thankfully none resulted stopped for a breather on enough. With the generous in more than scrapes and help of many members of the hills, but I could start 3 bruises (some quite MSPC, I made the minimum minutes later and my legs extensive hematomas pledge level in early felt fresh and ready to though). One woman fell climb. March. With pledges coming asleep while riding and in even as I was riding, I Heading down the other suffered a concussion in made it to my goal of side, just as steep, with a the resulting fall; she $10,000. by the final day. broken-pavement shoulder, a spent the night under bumpy white line to follow, In all, $1,261,000. went observation in the local and coal trucks roaring by into the coffers of the hospital. Many riders had three feet to the left at ALA. Some went for occasion to "use" their expenses of the Trek, but sixty mph, the thought helmets, including yours occurred to me that an within a tightly controlled truly. (Helmets were budget. Most of the money unexpected twist of the required gear at all goes back to each of the 30 handlebars would turn me times, and were without states represented by into road hamburger in an question the most impor­ cyclists on the Trek, in instant. After all, I was tant item of safety gear going 40 mph!! The moment proportion to the amounts anyone h ad.) Two men, in raised by each trekker. hangs crystallized in my separate incidents, The 22 Washington trekkers memory: terror, confidence injured shoulders, one raised over $140,000 for that I could make it, separated, one fractured the state chapter. prayer that the Lord would clavicle. Heat exhaustion I was the only MD on agree with me, and my hands caught up with 6 or 7 the Trek, but I was not a firmly wrapped around the riders in our many days of member of the staff. I drops of my trusty Nishiki, over 90 degree heat. All went along for the ride! weight planted on the of these were handled The medical support was pedals and seat equally. quite well by the Trek excellently organized and The truck rumbled on, I medical staff.

MSPC NEWSLETTER 6 SEPTEMBER, 1987 The Medical Society of Pierce County welcomes the following who have made application for membership into the Society. As outlined in the Bylaws, any member who has information of a dero­ gatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of the Society.

SEPTEMBER READINGS

ROBERT J. BOYER, M.D., Emergency Medicine. Born in Newark, NJ, 4/29. Medical School, Chicago Medical School, 1979; inter­ nship/residency, Christ Hospital, Oak Lawn, IL, emergency medicine, 7/79-6/82. Washington State License, 1987.

JOSEPH P.M. BYRNIij M«Bt> Anesthesiology. Born in New Rochester, NY, 6/45. Medical School, University of Illinois, 1977; inter­ nship, Mayo Clinic, pediatrics, 6/77-7/78; residency, University of Miami, anesthesiology, 7/78-4/79 and 4/80-8/80 and Ohio State University Hospital, anesthesiology, 8/80-8/81. Washington State License, 1987. Dr. Byrnes is currently practicing at Lakewood H o s pital.

THEODORE G. GOLDFARB, M.D., Pathology. Born in Oceanside, NY, 4/31. Medical School, Ohio State University, 1957; internship, University of Colorado Medical Center, 7/57-6/58; residency, Huron Road Hospital, Cleveland, OH, pathology, 8/61-7/62 and Cleveland Clinic, pathology, 7/63-6/66. Washington State License, 1977. Dr. Goldfarb is currently practicing at 3582 Pacific Avenue, Tacoma.

THEODORE A. MANOS, M.D., Anesthesiology. Born in Tacoma, WA, 10/55. Medical School, University of Washington, 1983; inter­ nship, University of Michigan, 6/83-6/84; residency, University of Michigan, 6/84-6/86. Washington State License, 1987.

JESSOP M. McDONNELL, M.D., Orthopedics and Metabolic Bone Disease. Born in Washington, D.C., 9/49. Medical School, University of Texas Health Science Center, 1981; internship, Akron General Medical Center, Orthopedics, 7/81-6/82; residency, Akron Medical Center, Orthopedic Surgery, 7/82-6/86. Washington State License, 1987. Dr. McDonnell is currently practicing at 1624 So. I Street, Tacoma.

BRIAN W. REAGAN, M.D., Emergency Medicine. Born in Tacoma, WA, 2/44. Medical School, University of Washington, 1970; inter­ nship, San Francisco General Hospital, 7/70-6/71. Washington State License, 1985. Dr. Reagan is currently practicing at St. Joseph Hospital.

JAMES S. REED, M.D., Gastroenterology. Born in Delaware, PN, 11/46. Medical School, University of North Carolina, 1972; internship, University of Chicago, 6/72-6/73; residency, Univer­ sity of Chicago, 7/73-6/75; graduate training, University of Chicago, gastroenterology/hepatology, 7/75-6/77. Washington State License, 1987. Dr. Reed is currently practicing at B-4006 Allenmore Medical Center, Tacoma. Continued on Page 10

MSPC NEWSLETTER 7 SEPTEMBER, 1987 RETIREMENT BECKONS DISCHARGING A PARLIAMENTARY PROCEDURE FOR 15 MEMBERS PATIENT.. PROCEDURES COURSE OFFERED Nearly 400 years of Occasionally the Medical Dr. Stan Tuell and Tacoma practicing medicine in Society will receive a call Community College will Pierce County came to an from a physician’s office again offer the popular end when 15 members of the wishing to terminate evening course on Par­ Society decided to "hang up patients from their care. liamentary Law and Proce­ their shingle" in 1987. It is considered unethical dure. and unprofessional conduct Dr. Bowe, President and the to "abandon" a patient. Knowledge of parliamentary Board of Trustees have However, to avoid charges procedure is a necessity if acknowledged the many of patient abandonment and you will be attending contributions these members to manage the discharge meetings of the organiza­ have made to their properly, the following tions you belong and IT will patients, the community and steps should be taken when enhance your ability to the Society. Their terminating care to a achieve your goals at the meetings. contributions have been patient: 1) Send a many. Dr. Kanda, Dr. Lane certified letter to the Dr. Tuell, a Registered and Dr. Bischoff each patient, return receipt served as President of the requested, stating that Parliamentarian (only 32 in the state and the only Society and played an future care will not be active role in its ac­ provided and stating the physician) was also Speaker of the WSMA House of tivities as did the others reason (failure to follow in the committee structure. medical advice, keep Delegates for the unprece­ dented period of 17 years. appointments, financial The best wishes and thanks irresponsibility, incom­ His classroom presenta­ tions and take home of the Society membership patibility, etc.. MSPC go to the following for a office has sample letters materials enable the student to enter the Board healthy and enjoyable available) 2) Offer to retirement. provide emergency care for room well prepared. a defined period of time John R. Alger .... 1960* until the patient can make The course consists of eight evening, two hour Guus W.C. Bischoff... 1959 other arrangement, but in classes beginning September Roger S. Dille 1947 any event not more than 30 28, Tacoma Community Dudley Houtz ...... 1956 days; 3) Offer to forward College campus. For more Edmund A. Kanar .... 1955 medical records to a new information call Dr. Tuell John M. Kanda ..... 1956 physician and enclose a at 927-1117 for a registra­ Jack E. Kemp ...... 1970 records release authoriza­ tion form call 566-5035. Robert E. Lane .... 1951 tion form; 4) If you wish, Michele Maddalosso..1966 you may refer your patient William Mcllroy .... 1976 to the MSPC referral Ray Miller ...... 1968 service to locate a new Harvey Sales ...... 1975 physician. SPORTS MEDICINE CONFERENCE J. Lawrence Smith ..1966

Sports medicine ’87 "FITNESS: NEW CHALLENGES AND CONCEPTS, is the theme The Symposium is scheduled of this years sports to begin at 8:00 a.m., medicine Symposium spon­ Saturday, October 3, 1987, sored by the 50th and Clarkmore Elementary 6250th General Hospitals School, Fort Lewis, WA.. of the US Army Reserve and Registration fee is $5.00. Madigan Army Medical Center. For more details, call 967- 5046___ WAMPAC (bottom next column)

MSPC NEWSLETTER 8 SEPTEMBER, 1987 Trek, cont. country, from all of you MEDICAL LIBRARIAN RECIPIENT I did provide support here in Washington to the OF to the staff and to family of two little girls RECOGNITION AWARD Trekkers whenever asked (on and their parents carrying the average twice a day) . ice water to the road to At the graduation cere­ Often it was simply refill our water bottles monies held by Tacoma reassurance or advice on after a long hill in Family Medicine for Family riding techniques to Pennsylvania. The chance Practice Residents on June minimize neuritis for to renew my spirit and 26, 1987, at the Tacoma instance. I arranged for sen se o f self, to a c ­ Golf and Country Club, a prescriptions through local complish a dream, and to plaque was presented to physicians for refills of sh a re in th e grow th o f many Marion von Bruck, Medical seizure medication, individuals (myself Librarian, citing her ointment for con­ included). The chance to outstanding service and junctivitis, and clotrimaz­ have fun (I have never continued support of the ole for the ubiquitous laughed more in six weeks) program since it was yeast infections which and benefit a good cause at established in 1978. The plagued many o f th e women the same time. The plaque was presented by Dr. riders. I shared pearls on opportunity to know that I William F. Hennessey, third treatment of back ailments am blessed to be able to year resident, in the with a physical therapist call one of the most company of faculty, family on the trip (as a Trekker). spectacular areas in the members, and other honored We had no lack of subjects country home. g u e s ts . for demonstration. I Thanks to all of you assessed two individuals for your support, to me with abdominal pain, to personally, to the Lung help determine if indeed Association, and to my they needed to be seen at a patients in my absence. hospital that night. I I t ’s good to be back. felt privileged to be able to help fellow riders with ray knowledge and training. What d id I g e t o u t o f it? The chance to eat. as much of anything I wanted, from donuts to pasta, Working miikshakes to French Solutions toast,...and to lose 10 pounds in doing so . The Professional Services chance to experience this amazing co u n try f i r s t hand, For The Injured K ith all my senses working 410 S.W. 153rd St Seattle, WA 98166 every s in g le moment to ta k e (206) 244-5460 it all in: the changes in Serving all Pierce and King Counties-near SeaTac Airport terrain and weather (dry hea t to wet heat), th e grandeur of the Rockies, Physical Capacities the desolation of the High Plains, the increasing density of population as Evaluations one moves E a s t. The Ronald S. Winkle, M.D., Director opportunity to feel the kindness and support of people all across the

MSPC NEWSLETTER SEPTEMBER, 19 87 Continued from Page 7

THERESA M. TEREM, M.D., Colon Rectal Surgery. Born 12/56. Medical School, Loyola Medical School, 1981; internship, Univer­ sity of California Irvine, 7/81-7/82; residency, University of California Irvine, 7/82-7/86; graduate training, Cleveland C lin ic, 7/86-7/87. Washington S ta te License, 1987. Dr. Terem is c u r re n tly p ra c tic in g at 902 So. L S tr e e t, Tacoma.

AMA FILES BRIEF WITH Group Practice Opportunity SUPREME COURT

The Virginia Mason Clinic in Moundake Terrace, Washington has an exceptional practice opportunity for a BC/BE Family Practitioner to join five other MDs (four FP, one IM). Experience preferred. Obstetrics The AMA has f i ] ed its brief capability optional. with the U.S. Supreme Court asking i t to review the This climc is a satellite of the Virginia Mason Clinic, a large subspecialty decision of the U.S. group practice in Seattle. Backup and referral care is available at Virginia C ircuit Court of Appeals Mason Medical Center as well as in the community. f o r th e first Circuit that upheld the constitution­ The position offers a salary and excellent benefits. Mountlake Terrace is located in south Snohomish County halfway between Seattle and Everett. a l i1 y o f th e M assachusetts statute which requires physicians to accept the Please send C.V. or contact Hinda Schnurmart, Clinic Manager Virginia Mason Clinic-Mountlake Terrace Medicare "reasonable" 23109 55th Ave., West • Mountlake Terrace, WA 98043 charge as a condition for (206) 774-2121 medi ca1 1i censure.

The high court is expected to decide later this year The practice losses whether to hear the case. In question is whether, you don't think about. under the Supremacy Clause (if the United States Constitution, a state law If you are too busy caring for your patients to be involved may elim inate an option in the business of your practice, then you need a proven which Congress specifically office system managed by outside computer professionals. enacted and deliberately preserved to ensure the With embezzlement, you lose money. proper operation of its With lost time, you lose productivity. federally funded and With bad data, you lose both. federally administered Whether you have one employee or hundreds, managing health insurance program. your own office computer system simply doesn’t pay. Just ask over one thousand doctors who have switched to In enacting the Medicare PRODATA CAREFREE COMPUTING. They will tell you how Act Congress deliberately we manage your system, verify controls, mail statements, gave physicians the option transmit claims, secure your data, and for less than doing to charge Medicare benefi­ it yourself. ciaries an amount which exceeds the Medicare Call Prodata Systems, Inc. 1-800-422-7725 or write reim bursem ent le v e l. The 2333 Western Ave., Seattle, WA 98121 for our brochure. Massachusetts statute A guide to explicitly eliminates this 3 federally-created option. o ■o Carefree 2 a Computing,

MSPC NEWSLETTER 1 0 SEPTEMBER, 1987 AUXILIARY NEWS combined with that special camaraderie that exists Crossroads Treatment Center within the Medical Alcoholism Auxiliary. Your check for $55 will bring all this A Program Designed to Provide LETTER TO THE EDITOR Comprehensive Treatment for (and more) to your life - All Facets of Alcoholism as reservations can easily Dear Medical Society of be done by telephone. Physician Directed Pierce County, Send your check to the Family Treatment Included Dues Treasurer: Helen We would like to expi’ess Whitney, 1736 Fairview Dr. Cost Effective Outpatient our heart felt thanks to S., Tacoma WA 98465. Oh P ro g ra m the Medical Community for yes, I seem to have an the outstanding care, Covered by many Health over abundance of stamps Insurance Plans support, prayers, and love, so if you need one for we felt through this time mailing, contact me and FOR INFORMATION of need that we just I ’ll be glad to send it to CONTACT: experienced. you. Ted Berning, Administrator Much of the blood that was Ginnie Miller 5909 Orchard St. West received has been replaced Tacoma, WA 98467 by you, PLU students, and (206)473-7474 yes, believe it or not the legal community.

We hope that we can someday GOURMET DINING return all this love and CROSSROADS concern in like manner. It TREATMENT CENTER is a wonderful thing to The Medical Auxiliary know that we have such a Gourmet Group has scheduled An Approved Washington Alcoholism caring and well qualified their first dinner of the Treatment Facility medical community. year for October 24th at the home of Bob and Debbie Sincerely, McAlexander. The theme is a regional one - New England. This group Charles and Cindy Anderson strives for authenticity and Family and a committee member is going to the Cape Cod area early in the month, and will send back recipes and possibly an ingredient or two. This attempt for "An Apple a Day..." "perfection" will probably Does What? not be duplicated any other time so if you are inter­ Actually, this isn’t the ested -contact one of the time (or publication) to following committee complete that old saying. members: Debbie However, if you don’t send McAlexander, Carol Hazel- Ron Williams in your dues - you will be rigg, Ginnie Miller. Realtor kept away from a year of fascinating programs, R esidential Sales intriguing luncheons (and 752-6696 Office even a November evening 752-7069 Eves. meeting with super desserts and an address by W.H. Opie & Co. Realtors Joe Pescatella "Don’t Eat 5738N. 26th Your Heart Out") all Tacoma, W A 98407

SEPTEMBER, 1987 MSPC NEWSLETTER 11 ^DIAPER RASH^ IS NOT A W AY OF LIFE

You can recommend professional $27,495 diaper service with confidence. (Volvo 760 GLE Sedan)* • Laboratory Controlled. Each month a random sample of our diapers is RICH NAN, subjected to exhaustive studies in a biochemical laboratory. sG 3 J0 fl • Utmost Convenience. Thanks to pick up and delivery service, our product comes when you need it.

• Economical. AM this service, all this p ro te c tio n against diaper rash costs $63,900 far less than paper diapers — only POOR NAN. pennies more a day than home- (Mercedes 560 SEL Sedan)* washed diapers. CAUTION TO YOUR PATIENTS. It is illegal to dispose ol human excrement in garbage. Parenls are doing this with paper/plastic Topping Motors diapers. "Disposable" is a misnomer. Volvo-Nissan Baby 925 Market Diaper (Downtown) Tacoma & Service 572-3333 TACOMA WA TOLL FREE 383-BABY 1-800-562-BABY * Manufacturer's suggested retail price including destination charges, Prices exclude state and local t optional equipment, special equipment required by states, dealer prep, and registration fees. Washington's Oldest, Most Trusted Prices may change without notice. Copyright 1987 Volvo North America Corporation Professional Diaper Service I Serving Our Second Generation *«F WSMA Annual Meeting

SEPTEMBER 17-20

Tacoma Sheraton, Tacoma.

Medical Society of Pierce County B U L K RATE U.S. POSTAG! 705 South Ninth Street, Suite 203 PAID Tacoma, WA 98405 TACOM A, WASH P ER M IT NO. 60! MSPC L

J ^ ft. [ft ^ jft.ft A publication of he Medical Society of Pierce County

VOL. 2, NO. 7 705 South 9th, Suite 203 OCTOBER, 1987 Tacoma, Washington 572-3667

100 MSPC members at the DR. RALPH JOHNSON MSPC again had a full September 8 General delegation representing it Membership Meeting. They ASSUMES PRESIDENCY at the Annual Meeting held outlined actions being at the Tacoma/Sheraton. It taken to combat the OF WSMA has become a tradition that Initiative. Members in MSPC and Tacoma hosted the the Society is one of the attendance at the meeting 98th WSMA Annual Meeting (Cont. on page 11) came away knowing that September 17-20. Over 500 WSMA has a well organized members attended the House INITIATIVE 92 effort to win on November of Delegates and Scientific November 3 is only 30 days 3. Program held at the Tacoma- away! Have you been Sheraton and Holiday Inn talking to your patients Drs. Bowe, Bodily, Hawkins respectively. about Initiative 92? and Mr. Jackman attended a A highlight of the meeting Recent public opinion data Speaker’s Workshop in July was the inauguration of shows that contact by arranged by WSMA to prepare Dr. Ralph A. Johnson, "your personal physician" them to make presentations Tacoma surgeon as Presi­ is a significantly to various groups. The dent of WSMA. A long-time credible source of speakers have been busy, activist in organized information. they have appeared before medicine, he and JoAnn the following groups: settled in Pierce County You must take the time to Weyerhaeuser Retirees in 1962 after completing discuss 1-92 and mandated Tacoma Narrows Rotary his residency at Mayo assignment with your Daffodil Valley Kiwanis Clinic. patients and to distribute Fife/Milton Rotary the explanatory material Lakewood Chamber of Comm. He served on the MSPC Board available free of charge P.C. Clinic Managers of Trustees 1976-78 and as from the WSMA or MSPC Physician Assistants President in 1978. He was offices. Puyallup AARP #216 a member of the WA. St. Tacoma AARP #1014 Medical Disciplinary Board The explanatory material P.C.C.M.A. 1978-82. He has served the (brochures, pos ters)i s Talk to Your Patients WSMA in many capacities. available by calling the Again, the importance of Ralph was the first MSPC office. Members of talking to your patients Chairman of the WSMA the PCMS Auxiliary under about 1-92 cannot be over Hospital Medical Staff the guidance of Legisla­ emphasized. Recent public Section and was a member of tive Committee chairman, opinion data shows that the WSMA Delegation to AMA JoAnn Johnson will be contact by "your personal 1983-87. distributing the material physician" is a sig­ to doctors offices. Take nificantly credible source Congratulations to Ralph advantage of this service. of information. JoAnn. The membership extends its appreciation Dr. Ralph Johnson, WSMA Order you campaign for the tremendous commit­ President Elect (now materials today! Call the ment of time and effort President) and Mr. Tom Society office and that goes with the posi- Curry, WSMA Executive Auxiliary volunteers will tl0n'-MSPC NEWSLETTER Director, addressed over deliver them promptly, THE DOCTORS’ EXCHANGE T ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY

.Another First RARE COINS Why settle for just MAKE MONEY a phone number? FOR OUR CLIENTS.. With the new HOW ARE YOUR Information Display Pager you can receive During rhe posr 10 years rare coins patient name, hove ourpaced oil, gold, silver, nature of call diamonds, even real esrare, os o superior mvesrmenr. . . averaging AND telephone No. over 20% annual appreciarion. INSTANTLY! If you'd like more mformarion regarding building your own, personal Office: 272-4111 rare coin porrfolio please give me a Exchange: 272-3166 coll. Here ar HRCI we guaranree whor Locally owned and operated. w e sell, end, w herher you're a new invesror or a seasoned professional we offer: 908 Broadway, Suite 201 ■ INSTANT LIQUIDITY . . . Published Tacoma. WA 98402 bids rhar give PCGS cosh values ar any rime. M LIFETIME GUARANTY of coin aurhenridry B GUARANTEED REPURCHASE Ih e practice losses agreements ' I' ■ M m • I' ■ . ■ ■ COMMI55ION REE counseling and sales service ■ UPDATED sraremenrs of value ■ PEACE OF MIND . . . Wirh guar­ anteed PCGS coin grading If you are too busy caring for your patients to be involved ■ A 15-day return privilege in the business of your practice, then you need a proven If you're ocollecrororan invesror.. .HRG office system managed by outside computer professionals. w ans to work with you ro build o profitable porrfolio. With embezzlement, you lose money. With lost time, you lose productivity. PH HERTZBERG With had data, you lose both. Rare Coin Investments, Inc Whether you have one employee or hundreds, managing ^Please send m e m ore rare coin information N om e your own office computer system simply doesn't pay. Just ask over one thousand doctors who have switched to Address PRODATA CAREFREE COMPUTING. They will tell you how we manage your system, verify controls, mail statements, transmit claims, secure your data, and for less than doing Phone it yourself. Call Prodata Systems, Inc. 1-800-422-7725 or write 3 3 5 DOCK STREET SUITE 204 TACOMA. WA 98402 2333 Western Ave., Seattle, WA 98121 for our brochure. (206) 627-2883 dr 1-800-826-0039 A guide to A BONDED, LICENSED PROFESSIONAL Carefree s> Computing,

MSPC NEWSLETTER 2 OCTOBER, 1987 BOARD ACTIONS PIERCE COUNTY EMS SYSTEM- Auxiliary Report -"WHERE ARE WE AND WHERE | No Dues Increase for 1988 Mrs. Beverly Graham, ARE WE GOING" The Board of Trustees at President, PCMSA reported ,! its September 1 meeting that the Auxiliary is Dr. Clark Waffle, Program approved the 1988 Proposed gearing up to assist in the Medical Director, Pierce Budget which does not call STOP 92 campaign and a County EMS System addressed for a dues increase in committee is working the Board on the current 1988. This is the fourth closely with WSMA staff to structure of the EMS System consecutive year without a coordinate activities for and alternatives being dues increase. the WSMA Annual Meeting. recommended by the Tacoma/- Pierce County Health The Budget projects 1S88 The Auxiliary will be Department and Dr. Waffle. expenses to be $186,580 developing a new fund The proposals will be and total income $196,364 raising program to replace discussed at the September for an excess over the style show done in ’87’ Committee meeting with the expenses of $9,784. The Mrs. Graham reported. Committee making recommen­ reserves Eire expected to dations to the Board be $64,661 or 46.9% of the EMS Recommendations following that meeting. Basic Operating Expense to TFD (BOE). BOE is defined as SIXTEEN NEW MSPC the expense of maintaining Dr. James Fulcher, Chairman MEMBERS WELCOME!) the MSPC exclusive of the EMS Committee reported that expense of maintaining the the Committee had submitted BY BO All) . Medical Library and two recommendations on ALS College of Medical Transport to the Tacoma The Board approved the Education. Fire Department who would recommendations of the be letting a contract out Credentials Committee The Budget is based on 565 to an ambulance company for chaired by Dr. Richard full dues paying members. patient transport. The Waltman that 16 applicants Non-dues income for 1988 recommendations were: be approved for membership is estimated to be nearly (1) CONTINUITY OF CARE: into the Society. They 18% of budget. This is an the first responding are: increase over the 14% paramedic team should projected for 1987. maintain responsibility for Brian Berry, Ped. the paramedic services Edward L, Bitseff, Jr. Several actions taken by until the patient arrives Plastic Surgery Membership Benefits Inc. at the receiving facility. John C. Bruce j E.M. has seen the Society’s There should be no "hand C. Kevin Bulley, Anes. for-profit subsidiary off" of responsibility to a William J. Crabb E.M. become a profitable second team. John S . DimanJc, Ped. j holding. Placing the (2) IMMEDIATE TRANSPORT Barbara J . Fox, Derm. Bulletin on a quarterly CAPABILITIES: the first Patrick J. Hogan, Neur. basis and replacing it responding paramedic team Thomas J . Kimpel, Neur. with a newsletter has should be able to transport Mary A. Lee, Ob-Gyn resulted in big savings. immediately on all ALS Dennis L. Magnotto, E.M. Utilizing a laser printer cases. There should not be Lawrence A . Price, F .P . rather than typesetting need to await the arrival Jon L. Ruckle, I.M. has netted a savings of a second paramedic team John S. Smoots, I.M. without any dimini shment of transport capability. Ronald K. Sugiyama, Ophth. in quality of the Bul- Ian A. Whitcroft, F.P. j letin. (Cont’d on Page 9) ADVERTISING AND NEWSLETTER COPY MUST ARRIVE IN THE SOCIETY OFFICE BY THE 15TH DAY OF THE MONTH PRECEDING THE PUBLICATION DATE. ADVERTISEMENTS IN THIS NEWSLETTER ARE PAID AND NOT NECESSARILY ENDORSEMENTS OF SERVICES OR PRODUCTS.

MSPC NEWSLETTER 3 OCTOBER, 1987 POSITIONS AVAILABLE

Family Practice. Excellent opportunity with Seattle’s leading provider of Family Practice. Positions available throughout greater Seattle. Current license BC/BE in family practice. Attractive salary incentive/benefits. Contact CHEC Medical, 2200 6th Ave. #225, Seattle 98121, Debbie Phillips (206) 728-6888.

Immediate Openings - full time and part time positions and Directorship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice. Flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1-800-554-4405 ask for Lois.

Physician opening. Ambulatory care/minor emergency center. Full/part time for FP/IM/EM trained, experienced physician. Located in Tacoma area. Flexible scheduling, pleasant setting, quality medicine. Contact David R. Kennel, M.D. at 5900 100th St. S.W., Suite 31, Tacoma 98499, phone (206) 584-3023 or 582- 2542.

Board Certified, Board eligible internal medicine specialists needed. Several practice opportunities available group and solo. For more information please call Pat Bailey at 833-7711 or 248-4550.

KIEUROLOGISTS/NEUROSURGEONS - Haelen Medical Evaluations is an independent evaluation facility specializing in comprehensive medical examinations. We have a growing need for Neurologists/Neurosurgeons to participate in individual and panel evaluations in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the Physician’s available hours, Monday through Saturday. You are invited to join our growing number of Physicians who provide evaluations to our rapidly growing referral base. For further information please call 627-0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility.

HAELEN MEDICAL EVALUATIONS is an independent evaluation facility specializing in comprehensive medical examinations. We have a growing need for medical specialists to participate in individual and panel evaluations in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the Physician’s available hours, Monday through Saturday. You are invited to join our growing number of Physicians who provide evaluations to our rapidly growing referral base. For further information please call 627-0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility.

ORTHOPEDIC SURGEON - Haelen Medical Evaluations is an independent evaluation facility specializing in comprehensive medical examinations. We have a growing need for orthopedists to participate in individual and panel evaluations in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the Physician’s available hours, Monday through Saturday. You are invited to join our growing number of Physicians who provide evaluations to our rapidly growing referral base. For further information please call 627- 0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility.

PACIFIC N.W. OPPORTUNITIES. We have openings in the N.W. and California. Let us assist you. Send C.V. or call: Western States Physicians Service, 9605 Sunrise Beach Dr. N.W., Gig Harbor, WA 98335 (206) 851-6201.

MSPC NEWSLETTER 4 OCTOBER, 1987 In Memoriam built for his children Pictorial Directory Joseph E. Garzon, M.D. during an earlier summer. Expecting to see a few The Pictorial Directory, 1932-1987 boards more or less published by the Medical horizontally placed above Society of Pierce County, Our medical community was eye level, I was amazed to MBI, is now being dis­ deeply saddened on June 26, find, high above us, a tributed. Please check 1987, with the death by house so well constructed your copy to make sure the lymphoma of Dr. Joseph that a half dozen adults information regarding your Garzon. could have found safe listing is correct. We refuge there, under a make every attempt possible His close involvement with shingled roof, during the to insure the information cardiovascular surgery windiest of our northwest is correct, but mistakes do began in 1973 when he storms• happen. Please call the modified his own growing Medical Society office, surgical practice to assist It was my pleasure to work 572-3709 no later than on virtually every open with Joe in the Tacoma October 15th, to let us heart procedure to be Surgical Club and on know about any changes. performed for the next numerous hospital conmit- three years. His aptitude tees. He never said a The Pictorial that was and dedication to this task disparaging word about published in 1984 was done were then quickly noted by anyone, and always was able by a California Company every arriving cardiac to moderate particularly that left the Medical surgeon, and until his severe attitudes, so that Society with no access to terminal incapacity, his all concerned would realize the photos, advertisements presence for the most that another look was or any other information lengthy and difficult necessary before reaching about the book. We had to procedures was regularly an important decision. start from ground zero. requested. But this year, the entire Even in the later stages of book was done locally, from Joe was a precise man, with his disease, Joe was ready the photography to the an extreme level of ethical for work, at any time, on binding. conduct with his fellows. any operation. I am At one time, he strongly indebted to him for this, We encourage you to support considered writing a but only to a minor degree the advertisers in the book surgical textbook on compared to the attitudes as they make it possible to assisting at cardiac he expressed, and then keep the costs down. surgical operations. It is demonstrated, about working regrettable that he did not and living with a terminal If you have any comments because his methods for disease. He is missed about the Pictorial vein harvest, back and side greatly, but his life as Directory we would be table layout, vein prepara­ viewed by those who worked interested in hearing from tion and storage, and with him will not be you. Call Membership optimization of surgeon’s forgotten. Benefits at 572-3709. vein graft suturing technique have not been Cordell H. Bahn, M.D. equalled. Joe came by this easily, with a natural regard for precision and proper order. Once, on a picnic at his summer home on Hartstein Island, he invited me to walk up the hill behind the house to see a tree house he had

MS PC NEWSLETTER 5 OCTOBER, 1987 CALENDAR IF YOU’VE October Meeting Dates.. 2 . . .Comm, on Aging WAITED TILL NOW 6...Board of Trustees 13. .General Membership Mtg. TO BUY 14..Credentials 19..Medical-Legal 20..Executive Comm. m w m m 21..Public Health/Sch.Health 22..Fluoride Coram. v m m w s K E . 22..EMS Comm. WILL BE 28..Computer User Group ME BOSSES NIGHT Aj?v time o f year is a good time 10 boy z Vofvo Bui ihii couJd h r tfte bes! lime o f alL }kx'LMAv: nsnw, ysmr VuJvn> li^aScr i"< itflcnnp Mmtx.ihin{i im_Sv irrtprcvovc than The Pierce County Medical rd>±to «if itRV-cost rifym^'uiy. gotsJ p n c« uo ihc burupran luxury c s tb lha * aJrcady a grca valis for ihc mcocy...thc Voho 760 *nian cs u-Agon_ Assistants cordially Its value [Jtai'i evukn! in the 760‘s.curmrve list of sJandanj fcicures. Which includes glove-soft leather uphotsc^y, autom ate climate controJ artd a dm cr s seal v*Mh a invite you and your special adjustment ic f yo u r lower track. physician employer to VoNo supports you in ether u^jys. too. With a *Jiree-ycar limited w arranr/ ih n puts no limit on mileage.* A limited -warranty against nisi thaf la s s a nrm arlabte ciglrt attend Bosses Night on yeara.® Arid a roadside assistance plan Uva covcn you 24 to u rs a day, 365 days a ye2£ Su sec Vohro dealer ioon Ektufc ih= perlcci time io buy a \toivo 76& Tuesday, October 27 at the becomes a thing of the pait Fircrest Golf Club. Cocktails will be from 6:30-7:30, dinner 7:30- 8:30 with entertainment (provided by peers) beginning at 8:30. Your choice of dinner will be 760 Sedan or Wagon chicken cordon bleu $12.25 or prime rib $17.25. Invitations will be mailed to all Medical Society TOPPING VOLVO - NiSSAN "Your Quality Downtown Import D©aier° member offices or if you 925 Market (Downtown) Tacoma need more info, please call Mary Ann at 627-9184 or Dixi at 383-3325.

Specialists in medical malpractice insurance since 1945. Representing, CNA, ICA, St. Paul.

Service that goes beyond the contract. A full range of insurance coverage to meet all of your PERSING, DYCKMAN personal and professional needs. & TOYNBEE, INC. B ob Sizer Marge Johnson, CPCU INSURANCE BROKERS Doug Dyckman Rob Rieder John Toynbee Bob Cleaveland, CLU 705 South Ninth, Tacoma WA 98405 I 627-7183 Wayne Thronson Curt Dyckman

MSPC NEWSLETTER 6 OCTOBER, 1987 The Medical Society of Pierce County welcomes the following who have made application for membership into the Society. As outlined in the Bylaws, any member who has information of a dero­ gatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of the Society.

ALLEN M. CLARK, M.D., Pathology, Born in Boston MA, 11/15/38. Medical School, Jefferson Medical College, 1966; internship, University of Colorado, 6/66-6/67; residency, University of Colorado, pathology, 6/67-7/71. Washington State License, 1987. Dr. Clark is currently practicing at 3582 Pacific Avenue, Tacoma.

THOMAS L. DUMLER, M.D., Diagnostic Radiology. Born in Denver CO, 1/17/52. Medical School, Washington University Medical School, St. Louis, 1979; internship, Jewish Hospital of St. Louis, 7/79- 6/80; residency, Baylor College of Medicine, 7/80-6/83. Wash­ ington State License, 1984. Dr. Dumler is currently practicing with Tacoma Radiological Associates.

DAVID T. ESTROFF, M.D., Pediatrics. Born in Syracuse, NY, 1/15/48. Medical School, Hahnemann Medical College, 1976; internship, Emory University, pediatrics, 7/76-7/77; residency, Oregon Health Sciences University, pediatrics, 6/79-7/82. Washington State License, 1987. Dr. Estroff is currently practicing at 521 So. K Street, Tacoma.

STANLEY S.W. IP, M.D., General Surgery. Born in Hong Kong, 1/20/57. Medical School, University of Toronto, 1982; inter­ nship, Huntington Memorial Hospital, Pasadena, general surgery, 6/82-6/83; residsncy, Huntington Memorial Hospital, general surgery, 7/83-6/87. Washington State License, 1987. Dr. Ip is currentlj' practicing at 10109 Plaza Drive, S.W., Tacoma.

WILLIAM H. NICOLAUS, M.D., Anesthesiology. Born in Milwaukee, WI, 10/17/32. Medical School, University of Wisconsin, 1957; internship, Milwaukee Hospital, 7/57-6/58; residency, University Hospitals, Madison WI, anesthesiology, 5/61-4/63. Washington State License, 1980. Dr. Nicolaus is currently practicing at Puget Sound Hospital, Tacoma.

JARED C. ROGERS, M.D., Family Practice. Born in Santa Fe, NM, 8/2/54. Medical School, Southern Illinois University of Medi­ cine, 1978; internship, Silas B. Hays Army Comm. Hospital, 7/78- 6/79; residency, Silas B. Hays Army Comm. Hospital, 7/79-6/81. Washington State License, 1987. Dr. Rogers is currently practic­ ing at 11019 Canyon Rd. East, Puyallup.

MSPC NEWSLETTER 7 OCTOBER, 1987 PRACTICES AVAILABLE

PRACTICE OPPORTUNITY SOUTHWEST WASHINGTON STATE. Practice opportunity avail­ able for a BC/BE family practice physician in hospital-owned clinic in Randle, Washington. OB desirable. D.O. preferred; will consider M.D. Current physician is retiring; will assist with transition. Physician compensation package can be tailored to candidate’s needs.

Randle is approximately 20 miles east of Morton, WA in beautiful, rural southwest Washington State. Hospital is located in Morton. The area offers excellent outdoor recreational opportunities and relaxed lifestyle.

Send C.V. to: Patty House, Health Resource Service, Virginia Mason Medical Center, P.O. Box 1930, Seattle, WA 98111.

GENERAL

19’ FLYING SCOT, new sails, spinnaker rigged, great day sailer. $3995, call 581-1061.

Norman Rockwell Lithograph "Discovery” AKA "Bottom Drawer" artist proof, small edition. Call 584-6935.

New catalog. Over 500 items of office and medical equipment available at tremendous savings. Call Lynlee’s (206) 453-8892 for free copy.

Retiring? Call us regarding your used office equipment (206) 453-8892.

Antique exam tables. Call 453-8892.

SE RE’CO Associates specialists in crisis situations in office management and bookkeeping. Available for new office set-up. Call 927-6540.

EQUIPMENT

Merlin telephones, model 206. Standard 5 butoon set with control unit. $950.00. Call 584-3104 after 6:00 p.m.

Burdick ECG machine and stand $1474.00. 24 test isocult incubator $49.00. Evenings 588-7545, days Dr. Boyle 582-8440.

MSPC NEWSLETTER 8 OCTOBER, 1987 Board Actions Cont. IMPROVEMENT IN THE OR­ GANIZATIONAL STRUCTURE AND 'DIAPER RASH AIDS COMMITTEE THE LINES OF AUTHORITY HAD f t , The Board was informed that BEEN CLARIFIED." The IS NOT A WAY OF LIFE the AIDS Committee, formed motion was seconded and You can recommend professional in May under the Chairman­ unanimously approved. diaper service with confidence. ship of Dr. Alan Tice was ® Laboratory Controlled. Each month busy developing an AIDS MAXINE BAILEY a random sample of our diapers is resource guide and an COMMENDED subjected to exhaustive studies in a educational forum for biochemical laboratory. medical, dental and It was announced that Ms. • Utmost Convenience. Thanks to pick nursing home office staff Maxine Bailey, Executive up and delivery service, our product scheduled for October 28. Director, College of comes when you need it. Medical Education had • Economical. All this service, all this The Committee has repre­ submitted her resignation protection against diaper rash costs sentatives from the after serving in that far less than paper diapers - only capacity for over 19 years. pennies more a day than home- Tacoma/Pierce County washed diapers. Health Dept. , Hospital Maxine will continue to contract physician CME CAUTION TO YOUR PATIENTS. I! is illegal lo Administrators, Infection dispose of human excrement in garbage. Control and Social programs with the College. Parenls are doing Ihis with paper/plastic Workers, PCMS Auxiliary A motion was made and diapers. "Disposable" is a misnomer and School Nurses. unanimously approved that "THE MEDICAL SOCIETY EXTEND ITS APPRECIATION AND COMMITTEE ON AGING GRATITUDE TO MS. MAXINE l e w Concern was expressed by BAILEY IN RECOGNITION OF the Board that no Pierce TACOMA WA TOLL FREE HER 19 YEARS OF EXEMPLARY 383-BABY 1-800-562-BABY County nursing homes were SERVICE TO THE MEMBERS OF Washington's Oldest, Most Trusted reported to be admitting THE MEDICAL PROFESSION." Professional Diaper Service AIDS patients. A motion I Serving Our Second Generation I was made and approved that "THE EXECUTIVE COMMITTEE BE DIRECTED TO GENERATE A PORUM TO INSURE ADMISSION TO NURSING HOMES OF AIDS The practice losses PATIENTS." An effort will be made to improve ;you dop'tthink about. communications with nursing home medical If you are too busy caring for your directors and ad­ patients to be involved in the business of ministrators . your practice, then you need a proven offica system managed by outsicte computer LIBRARY COMMITTEE professionals. It was reported that the With wnbezztemeitl, you loss monsy. 1988 Library Budget would With lost time, you loss productivity. not be requiring an WAMPAC W ith bad data, yoy loss bottn. increase over the 1987 Whether you have one employes budget. However, the or hundreds, managing your own offica Board of Trustees had only computer system simply doeenl pay. Just approved the 1987 increase ask over one thousand doctors who have switched to PRODATA CAREFREE if it was essential to the COMPUTING. They will tell you how we Library to carry on its manage your system, verify controls, mail business. A motion was statements, transmit claims, secure your made that "THE 1988 data, and for less than doing it yourself.

FINANCIAL CONTRIBUTION OF Call Prodata Systems, Inc. THE SOCIETY TO THE LIBRARY 1-800-422-7725 or writ® 2333 Western ave., WOULD NOT BE MADE UNTIL Seattle, Wa 98121 for our brochure. THERE WAS EVIDENCE OF A guide to (Carefree tssr IComputing® MSPC NEWSLETTER BRS. ALENICK AND TOTH Group Practice Opportunity ELECTED TO STATE ------j The Virginia Mason Clinic in Mountlake Terrace, Washington has an j POSITIONS exceptional practice opportunity for a BC/BE Family Practitioner to join Dr. Leonard Alenick, five other MDs (four FP, one IM). Experience preferred. Obstetrics Lakewood Ophthalmologist capability optional. 1 1 and MSPC member since 1972 has been elected AMA This clinic is a satellite of the Virginia Mason Clinic, a large subspecialty ' group practice in Seattle. Backup and referral care is available at Virginia Alternate Delegate by the ■■ Mason Medical Center as well as in the community. ; just concluded WSMA House of Delegates meeting. The position offers a salary and excellent benefits. Mountlake Terrace is i; located in south Snohomish County halfway between Seattle and Everett. Dr. Alenick received his medical degree from Johns Please send C.V. or contact Hinda Schnurman, Clinic Manager ,j Hopkins U. School of Virginia Mason Clinic-Mountlake Terrace Medicine and has been 23109 55th Ave., West • Mountlake Terrace, WA 98043 active at state and (206) 774-2121 '' national levels with ______i 5 ophthalmology groups, rental and airline dis­ To purchase your copy of si counts, attractions and the ’88 Entertainment j Dr. Eileen Toth, Tacoma getaways all over the West Book, please call Member- :! internist and MSPC Trustee Coast. With the use of ship Benefits, was elected Alternate 572-3709. .just one or two offers, you Delegate to the AMA We will reserve your copy m will easily recoup the cost Hospital Medical Staff and will be happy to = of the book as well as be Section at the Annual answer any questions you !■ introduced to a wide Meeting of the WSMA might have. s' variety of new, quality Hospital Medical Staff - LI establishments and ac­ Section. tivities especially selected for your enjoy­ Dr. Toth, a graduate of ment. "BUYING THERAPY Harvard Medical School served as Chairman, OR j The South Puget Sound Department of Medicine, Edition of Entertainment 88 Humana Hospital, 1984-1986. RECEIVING CARE" Book is selling for $30.00 Si this year and features over !• v 70 fine dining restaurants, ■!. Eatertakmefit 83 including Hogan’s Bay Co., ^How the financial - iBooks Available El Torito, W.B. Scott’s, transaction affects i Garcia’s , Tacoma Salmon medical ethics in the U.S. The Medical Society will be House, plus many more. and Great Britain." Dr. selling Entertainment 88 Over 40 casual restaurants Kirk Rue, Tacoma anes- ‘ Books thru the MBI office and over 90 informal thesiologist, who has just beginning in October. When restaurants are also completed a year of study ;,li you purchase an Entertain­ included. The Tacoma in England will address ment 88 Book you can be Stars, Seattle Supersonics, the issue of medical ij confident you are purchas­ Longacres, Crystal Moun­ ethics at the October it ing the best. Your tain, bowling, tennis, General Membership § membership coupons and card golfing, among others Eire meeting. will allow you to take included in over 60 sports advantage of hundreds of >>! offers, and the special The meeting is scheduled ; two-for-one or 50% off for Tuesday, October 13, s] offers for some of your events sections offers favorite dining establish­ movies, theatre, symphony, Fircrest Golf Club, 6520 s ments , movies, hotels, and special attractions. Regents Boulevard. Social sporting attractions and Plus, over 300 hotels, hour begins at 6:00 p.m., 5 special events. Also airline discounts and West dinner at 6:45 and program included are great car Coast highlights are at 7:45. ;tj offered. ------*i MSPC NEWSLETTER 10 OCTOBER, 1987 K WSMA Annual COURT RULES best represented delega­ Dr. Mark Craddock was tions at the meeting. Chairman of the entire m FAVOR OF Scientific Meeting and is MSPC to be complimented on the The following members Judge Robert Bryan, U.S. represented you at the organization and quality of District Court ruled August Reference Committee the program. Several 12, that no conspiracy meetings and on the floor members chaired scientific existed between the Medical of the House of Delegates. sessions of their specialty Society and Good Samaritan societies; Drs. John Colen, Hospital to drive Scott L. Richard G. Bowe, President Robert Sands, David Munoz Havsy, D.O. out of practice William B. Jackson, and Robert Scherz. by disseminating false and President Elect misleading information Others members who Kenton C. Bodily, Vice regarding his background presented papers were; P re s id e n t and qualifications as a Drs. Robert Ettlinger, Robert B. Whitney, physician. Secretary-Treasurer Barry Weled, Larry Larson, Jacqueline Jorgensen, Eileen Toth Dr. Havsy contended that Frank Virant, Leslie Malo Gerald Anderson the hospital’s rejection of and John Mulligan Johann Duenhoelter his application for staff Peter Marsh privileges violated federal Leonard B. Alenick antitrust laws and the Charles L. Anderson state Consumer Protection Thomas H. Clark Act, which makes unfair David S. Hopkins M.D. SUPPORT GROUP competition illegal. James D. Krueger DeMaurice Moses Judge Bryan’s decision said Have you had a malpractice Gilbert Roller that Good Samaritan denied suit lately? Has it been G. Bruce Smith his request for staff a traumatic experience? Stanley Tuell privileges after learning Other members of the Havsy had failed to mention Charles Weatherby, Society have undergone that his internship at WSMA Trustee such experiences and have Brooke Army Medical Center Robert Scherz, offered to lend support to was involuntarily ter­ WSMA Trustee any member who may be minated . Ralph A. Johnson, enduring such an ordeal or WSMA President Elect is anticipating a call In granting the request for Richard Hawkins, from an attorney. Vice Speaker Suiranary Judgment, Judge Bryan said, "The Medical If you would like to talk Many members of the Society Society in providing Good to a colleague who has played major roles in the Samaritan Hospital with suffered through such an activities of the House of information concerning ordeal, please call Doug Delegates and the Scien­ Doctor Havsy, was acting in Jackman at the Society tific Program. conjunction with parties office— 572-3667. who were carrying out state Dr. Richard Hawkins, as policy. This was a clearly Vice Speaker of the House, articulated policy regulat­ impressed the many ing anti-competitive delegates with his mastery of parliamentary proce­ conduct of state-licensed hospitals, and was super­ dure. Dr. Peter Marsh, chaired Reference Commit­ vised by the state in a tee "B" that dealt with manner to invoke the "Parker" or "state action" several controversial doctrine. The Medical issues and Dr. Dick Bowe, Society’s challenged chaired the meeting site activities are therefore selection committee in determining the 1991 and exempted from federal anti­ trust liability." 1992 meeting sites.

t a ^ ^ iTT*innT n mmT 1 11 n r T n n u D 12th Annual St. Joseph Hospital Ball

Saturday, November 14,1987 Sheraton Tacoma Hotel Pavilion

Medical Society of Pierce County B U L K RA TE 705 South Ninth Street, Suite 203 U.S. POSTACE PAID Tacoma, WA 98405 TACOMA.WASH. P ER M IT NO. 60S

u S M m t l M lG IE/ll UORARy deceivedf e b 1 0

The Official Publication of the Medical Society of Pierce County MS PC Officers: Richard G. Bowe, President; William B. Jackson, President-elect; Kenton C. Bodily, Vice President; Robert B. Whitney, 4 President's Page Secretary-Treasurer; Richard Hawkins, Past It's Traum atic to Live in P ierce C ounty President.

MSPC Trustees: Michael L. Halstead, Peter K. Marsh, Paul D. Schneider, Johann H. 6 Newsbriefs Duenhoelter 1987; Gerald W. Anderson, Ronald Tuberculin Skin Testing Policy Guidelines W. Knight, Eileen R. Toth, 1988, Beverly AIDS & HIV Infection in Pierce County Graham. New Medical Directorfor Pierce County Medical Announced

Executive Director: Douglas R. Jackman

Board and Committee Chairman: 10 WSMA: Help for Impaired Physicians AIDS: Alan Tice; Bylaws Stanley Tuell; Budget/Finance:Robert B. Whitney; College o f Medical Education, Peter K. Marsh; 11 Prescribing to Methadone Clients Credentials: Richard E. Waltman; Em ergency By Terry Reid, Tacoma-Pierce County Health Department Medical Standards: James K. Fulcher Ethics/Standards o f Practice: Ronald G. Taylor; Grievance: Richard Hawkins; Interprofessional: Robert J. Martin; 12 WSMA Annual Meeting Legislative: Gregory A. Popich; Library: Gilbert G. Johnston; Medical Education: David Brown; Medical-Legal: Marcel Malden; 16 Recommendations for Prevention of HIV Transmission in Membership Benefits, Inc., Donald W. Health-Care Settings Shrewsbury; Personal Problems of Physicians, Pat Donley; Program : Kenton C. Bodily; Public From: JAMA, Sept. 11,1987. Health/School Health, Terry Torgenrud; Committee on A ging: David R. Munoz. 25 Tips for Physicians Giving Depositions The Bulletin is published quarterly, February, May, August and November, by the Medical Excepts from "The Deposition Guide: A Practical Handbook for Society of Pierce County, 705 South 9th, Suite Witnesses." Advice for health care professionals 203, Tacoma, WA 98405. Telephone (206) 572- 3666. Bulk Rate U.S. Postage paid at Tacoma, Washington. The Bulletin is published in the 26 Are Your Employees Eligible to Work for You? interest of medicine and allied professions. The opinions herein are those of the individual The ins and outs of the "Immigration Reform and Control Act" and its contributors and do not necessarily reflect the implications for your employees. By Sharon Bain, Assistant Director, official position of the Medical Society. Membership Benefits Acceptance of advertising in no way constitutes professional approval or endorsement of products or services 27 Terminating an Employee: Is There a Graceful Exit? advertised. The Bulletin and the Medical ;.«f| Society of Pierce County reserve the right to reject any advertising. (■' 28 Auxiliary News WSMA Convention '87 sw1' Editor: David S. Hopkins Calendar of Events Managing Editor: Douglas R. Jackman Special Thanks to Auxiliary Members

Editorial Committee: David S. Hopkins (Chairman), Stanley W. Tuell, W. Ben Blackett, 30 JAMA 100 Years Ago Richard Hawkins "Dire Consequences of a Physician Oversupply"

Production: Mary K. Tipton Advertising: Sue Asher, Membership Benefits, 32 General Membership Meeting Announcement Inc., Medical Society of Pierce County, 572-3709. Beverly Foley, 2607 Bridgeport Way West, Suite 2C, Tacoma, (206) 564-3839

Subscriptions: $20 per year, $2 per issue. Make ail checks payable to Pierce County Medical Society. 1987 November Th£ Bulletin President's Page It's Traumatic to Live in Pierce County

One of the obligations and organized plan for pre-hospital care Hospital appearto want to relinquish requirements bestowed on me this and a smoothly running base station) the designation to the other within year as your President has been to are being slowly and methodically the downtown area. Good Samaritan keep my ear to the ground whenever addressed by the EMS committee. feels the valley needs a comparable issues of quality of care or availability Sensing the need for a more rapid facility. Some have proposed that of services are discussed. Like all and authoritarian solution, the TPCHD Madigan with its training program and Society presidents who preceded is preparing an organizational plan full-time inhouse staff would best fill me, this includes sitting in on many of with the director of the Health the need. our Society committee meetins, Department as the designated What are the real concerns, pro discussing the issues in the OR and authority to set and enforce standards and con, of the hospital adminis­ doctor's lounge, and reading many for emergency medical care. A trators? It seems to me that the major articles addressed to the Society or counter-proposal by Dr. Clark Waffle reasons for wanting the sole trauma written in the local press. would put that authority in the hands designation are (1) the non-economic There have been many issues of the EMS Council underthe or prestige advantage that goes with deaing solely with our internal Society direction of the Board of Health. It is being a "full service" hospital, and (2) interests such as COME, MBI and the still uncertain whether any of these the "capture" of "spin-off" of non­ Library. Certainly these are important plans would address the issue of a trauma emergencies either at the to us as an organization, but overall designated trauma center and request of the patient or by the don't mean a thing in our most improving trauma care. transporting agency. According to important concern of all—the best What about trauma care? Is it as Flynn, who left TG to work in Seattle medical care possible for our patients. big a concern as some would lead us and helped develop Harborview's I've been impressed this year as I to believe it is? We all read the TNT's trauma center, that effect has been a have in the past that your leaderhship week-long series in July criticizing major problem for Seattle's other both at county and state level have Pierce County trauma care. Certainly, major hospital as Harborview's put the common good of our many people's feathers were ruffled program has become known and community and patients ahead of any by the comments made and many nationally admired. This may be in self-serving and purely economic were critical of them. Nevertheless, part due to the strong affiliation of the gains. facts and statistics were presented many EMT's who have trained at One of the most controversial and which point out the trauma system Harborview. I would argue that if a frustrating problems that concerns us isn't as effective as it should be. strong, independent-of-hospital- now as it has in the past is the issue of Maybe the TNT wasn't the appropriate control. base station was created, this emergency medical services and, body to bring this out - but it did. effect would be minimized, provided more specifically, trauma care. Sitting Now they aren't in a positon to go any adequate criteria were established for in on a 7:00 a.m. EMS committee further with it. Who better than the trauma center referral. montly meeting is a trauma in itself. Medical Society can respond to the The main reason for not wanting Watching Dr. Jim Fulcher, as problem and take the lead to outline a the designation would seem to me to chairman, and his emergency- plan to correct it. be economic. Estimates range from a oriented committee tackle the This isn't a new issue. I recently low of $400,000 to over one million problems of "cowboy" paramedics in spoke with Bob Flynn, administrator dollars per year to provide an in- rural Pierce County, Fire Department of Tacoma General Hospital from house surgeon in the ER 24 hours aid cars who are often first on the 1966 to 1972, who stated that, with every day. Probably only a small scene but can't transport patients, the emergence of the full-time ER percentage of that cost would be met and the competition among physician during that era, the by fees since many trauma victims are ambulance companies points out the concerns of providing quality trauma poorly insured. sad state of affairs in pre-hospital care. care comparable to Seattle's were I'm sure that our hospitals are The lack of a central base station to considerable. studying the issue of trauma care in efficiently direct traffic and serve as a The question of whether or not a terms of expense, capabilities, review center to evaluate the quality single hospital should be the prestige and potential profit. Your of pre-hospital care is the second designated trauma center is a Societies' leadership met with all the weak link in the system. These two sensitive political issue. Neither area hospital administrators this important building blocks (i.e. -- a well- Tacoma General nor St. Joseph Continued on page 5. 4 The Bulletin November 1987 President' Page Continued... As I stated earlier, I think it is time isn't just mortality figures that are the Medical Society takes the lead in important, but that the morbidity from sum m er. Although none appeared evaluating the present system and trauma care (i.e. - translating into willing to relinquish their present suggesting remedy, if appropriate. It ultimate quality fo life) is an equally position, we came away with the seems to me it's time to forget politics, important consideration. I urge you all feeling that, in the interest of the economics and ego and work toward to give this your utmost community, any hospital interested in a rational evaluation of whether we consideration. Let me know your trauma will address the issue in a way need a trauma center and, if so, how feelings. We owe it to our patients to that w ill most effectively and we go about it. We need to study be the best that we can be.D economically use and enhance ourselves and ask for advice of others Tacom a's excellent medical who have gone through this process Richard G. Bowe resources. already. We need to remember that it The hospitals aren’t the only element of concern in evaluating the trauma issue. Presently 14 general surgeons rotate on a trauma call roster to provide f rom-home coverage of the area's hospitals. They are primarily involved in coverage for TG and St. Joseph, but several of them cover the others as well. We should be proud ol their efforts and dedication as many of them are working in surgical sub­ specialities unrelated to trauma, but continue to serve from a deep sense of committment. Their rewards are poor payment, rotten hours and frequent criticism. Many feel that the on-call system isn't good enough-that the only way to save lives in trauma cases is to have a full-time trauma surgeon available. Risk is another important concern in dealing with trauma. Any doctor works hard to treat and protect his patient -- those dealing in trauma care need to protect themselves. Trauma victims are generally young with years of earning power ahead of them. h When a trauma system doesn't Rob Ricder Marge Johnson, CPCU respond rapidly and efficiently the result is that the patient may die and there may be legal repercussions. A doctor can count on being named in such a lawsuit. It is in the interest of all ooctors to work for a system that will minimize that risk. I guess the question I would ask each of you is whether you think the Gerard Delisle system we have now is adequate or Curt Dyckman as many have emphatically stated, "we need something better." I agree PI)&T with Dr. Bob Osborne Jr. who says we need to see proof that a trauma center would provide better survival rates than we have now. He feels we should do both a retro and prospective study of hospital and Bob Cleavcland, CLU, ChFC autopsy records. A retrospective Over 40 years experience study of 31 selected trauma deaths specializing in service to professionals. overthe past two years by 2 Persing, independent trauma surgeons, both Medical Malpractice Dyckman & outside Washington, indicated that as Property • Liability • Group Toynbee, Inc. high as 35% of them may have been D isability • Auto • H om e • Life saved if treated in an organized Insurance trauma system. Brokers 627-7183 705 South 9th, Tacoma, W A 98405

1987 November The Bulletin 5 Tuberculin Skin Testing The Board of Trustees approved health supervision examinations same manner as unimmunized the following policy on Tuberculin inquiry should be made regarding individuals, using the criteria outlined Skin Testing of Children in Jan., contact with tuberculosis, and above. Because of the wide variation 1987. Dr. David Sparling prepared additional tuberculin testing carried in BCG material in use throughout the the guidelines for the Public out in case possible contact is world, reliable judgments cannotbe Health/School Health Committee. reported. made about the degree of protection The tuberculin skin test is most afforded to vaccinated individuals. Heretofore it has been the useful when applied selectively to Because many BCG vaccinated recommendation of the American individuals having special risks. persons come from areas of high Academy of Pediatrics that children Tuberculin skin tests are recommend­ prevalence, it is recommended that receive tuberculin skin tests at 9 to 10 ed at the time of identification of risk individuals from this group who have a months of age, annually thereafter and at least annually throughout the positive tuberculin skin test should during the preschool years, and at risk period for the following groups: also be evaluated to rule out active each periodic health supervision • Persons with signs and tuberculosis. examination for the rest of childhood. symptoms suggestive of current When tuberculin skin testing is The Public Health/School Health tuberculosis disease restricted as recomended above, the Committee of the Medical Society of most sensitive test is the Mantoux Pierce County has recommended • Persons with abnormal chest ro­ test. The Mantoux test is perforemd that tuberculin skin testing be a part of entgenograms compatible with by the intradermal injection of 5TU of all examinations for day care, past tuberculosis PPD, with a positive reaction being preschool, school, camp or sports recorded when 10 mm or more of participation, unless performed and • Persons with medical conditons that increase the risk o tuber­ induration is found 48-72 hours after recorded during the previous 12 injection. A negative or nonsignificant month period. culosis (diabetes, lymphomas, immunosuppressive therapy) tuberculin skin test does not exclude Since these recommendations tuberculosis infection or disease, were prepared there has been a • Groups at high risk of recent since in some cases individuals with substantial decrease in the incidence infection (immigrants from South­ active tuberculosis may fail to react to of tuberculosis in our communities, east Asia, Africa and other geo­ PPD tuberculin; this is particularly true substantially reducing the benefits to graphic areas of high prevalence, in persons with severe disease, those be achieved by routine annual or those with a history of substantial with renal failure, the elderly, and frequent tuberculin skin testing. continuing drug or alcohol abuse, individuals receiving corticosteroids. The Public Health/School Health those who are severly deprived in A booster phenomenon may also Committee of the Medical Society of either housing or nutrition, em­ occur when a positive test occurs on Pierce County recommends that ployees and residents of institu­ retesting after a previous small (less henceforth tuberculin skin testing is tions in which tuberculosis is than 10 mm) reaction. This is a true desirable for all children in Pierce liable to be prevalent. positive and should be considered County at the following times: when the initial Mantoux result is • At 9-10 months of age priorto Individuals with positive questionable. the MMR vaccination tuberculin skin test should receive Multiple puncture tuberculin skin appropriate diagnostic and treatment tests are also interpreted at 48-72 • At 5 years of age at the time of procedures and should usually not hours. Reports now in the medical pre-kindegarten physical have repeat tuberculin sking testing. literature indicate that the Monovac examination Individuals with active tuberculosis tests is 95%-99% sensitive as • At 11 -12 years of age priorto should, and those with positive compared w ith the M a n to u x technic. middle school enrollment tuberculin skin tests may, be reported Accuracy of other multiple puncture to the Tacoma-Pierce County Health tuberculin skin testing technics, as • At approximately 15 years of Department for diagnostic and currently reported in the medical age priorto high school treatment procedures and contact literature, may be considerably less, enrollment. investigation. since false positive tests may occur (A pre college tuberculin test is also Individuals with a history of desirable.) previous BCG vaccination should At the time of all other periodic receive tuberculin skin tests in the Continued on page 7. 6 The Bulletin November 1987 Tuberculin Skin Testing Policy Guidelines with multiple puncture technics, recommended tuberculin skin American Thoracic Society Control of Tuberculosis: Official Statement of the these tests must be considered testing, and that these guidelines Amencan Thoracic Society Joint Statement screening procedures, and all should, as in the past, be distributed with Centers for Disease Control. Am. positives must be verified by a for guidance of schools, preschools, Rev.Res. Dis. 128:336, 1983. standard Mantoux test performed camping organizaitons, private immediately afterwards, either at the American Thoracic Society The Tuberculin Skin practitioners, and other caretakers of Test: Official Statement of the American physician's office or the health children. The Committee Thoracic Society Joint Statement with the department. recommends that these guidelines Centers for Disease Control. Am. Rev. Res. The Committee believes that be reassessed in two years. Dis. 124:3,1981. these recommendations, while primarily addressing skin testing of References: Kearns, T.J., etal. Public Health issues in Knowland, R.J., ChildhoodTuberculososin control of tuberculosis. Chest 87:135S, 1985 children, may be appropriately applied North Carolina: A study of the opporunities for in developing policies for tuberculosis intervention in the transmission of tuberculosis Marcuse, E.K , M.D., Chairman, Committee on screening among those who care for to children. AJPH 76:26, 1986. Infectious Disease, Washington Chapter adults. The Committee recognizes American Academ y of Pediatrics, personal Powell, K.E.,et all. Recent trends in communication 1986. that in many communities throughout tubersulosis in children. JAMA 251:1289, the country, because of extremely 1984. Leahy, R.H., M.D., Head, Chronic Disease low prevalence of tuberculosis, public Epidemiology Section, Washington State health authorities are recommending Barclay, W.R. The tuberculin test in 1980. Department of Social and Health Services, complete elimination of routine Editorial. JAMA 244:1134, 1980. personal communication, 1986. tuberculin skin testing of children and Bryan, C.S. Unread tuberculin tests. JAMA Donaldson J.C. and Elliott R.C. A study of co- adults or, in some cases, restricting 244:1126,1980. positivity of three multipuncture technics with such routine testing to one or two intredermal P.P. D. tuberculin. Am. Rev. Resp. times throughout a lifetime. The Brunell, P.A., M.D., Chairman, Amencan Dis. 118:843,1978 Academy of Pediatrics Committee on Committee feels that in this Infectious Diseases. Personal communication, Hall C.B. Skin tests for tuercufosis. Infectious community, because of the large 1986. number of international transients and Dis. Newsletter 29:9,1982. □ the substantial presence of high risk Sinder D.E., Jr., M.D., M.P.H., Director, population groups, the above Division of Tuberculosis Control, Center for David Sparling, MD guidelines represent the most Preventive Services, USPHS Centers for Disease Control. Personal communication, Submitted to Public Health School Health appropriate decrease in frequency of 1986. 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1987 November The Bulletin 7 Clinical Opportunities Newsbriefs continued for Smoking What Every Intervention... Physician’s Spouse i Dr. Boudwin named A Guide fo r the Busy Physician Should Know A series of booklets on topics of outstanding employee. As primary health care providers special interest to medical families Dr. James Boudwin isthe1986 for most Americans, physicians can published by the American recipient of the Fourth Annual DSHS play an important role in helping their Medical Association Auxiliary Outstanding Employee Award. patients stop smoking. Governor Booth Gardner Estimates show that if physicians presented the Award to Dr. Boudwin delivered stop-smoking messages to in a ceremony in Olympia, June 10, their patients as a routine part of 1987. Dr. Boudwin was the first physician office visits, at least 38 physician to be given the award since million smokers could be reached it was first presented four years ago. annually. Recently retired, Dr. Boudwin was The National Heart, Lung and a psychiatrist at Western State Blood Institute, the American Lung Hospital. He has been a member of Association and its medical section, the Medical Society for 30 years. the American Thoracic Society have developed a resource to help physicians provide credible health New Medical Director information to patients. The Guide describes how for Pierce County physicians can encourage patients to Medical. stop smoking in ways that are consistent with their medical practice Lester A. Reid, MD will assume the position of Medical Director for protocol. The guide is available at no cost Pierce County Medical, Oct. 1,1987. by calling the Lung Association office Dr. Reid practiced internal medicine in at 565-9555. Aberdeen for 11 years and served as Professional Liability part-time Medical Directorof Grays ■ Scope of problem ■ Legal process Harbor Medical Bureau for four years. ■ C o pin g Dr. Reid received his Impairment undergraduate degree and Master of ■ Causes ■ Impact on family Science Degree in Business St. Leo's Neighborhood ■ Getting help Administation and Engineering Survival Tips for Resident Physician/ Sciences from Dartmouth College. Clinic asks for help. Medical Student Spouses He worked as an engineer for ■ Marriage in the training years ■ Stress ■ Finances Honeywell and Boeing Company for a Dear Medical Society Members: Marriage Over the past 18 months, more number of years before attending ■ Who players are ■ Special Johns Hopkins University School of and more people hav come to the concerns ■ Stages of medical career Medicine. After attending medical Neighborhood Clinic with Retirement and Estate Planning school, Dr. Reid completed a prescriptions from Doctors in private ■ Making retirement years fulfilling residency in internal medicine at the practice, from the community health ■ Providing for the family’s future University of West Virginia Medical clinics and even from hospital Center. He also completed a one- emergency rooms. MAILORDER FORM TO: year Pulmonary Fellowship and a one- In addition, since January of American Medical Association Auxiliary, Inc. year Cardiology Fellowship. 1986, we have been running a 535 N. Dearborn St., Chicago, IL 60610 Dr. Reid is a member of the Psychiatric Clinic every Wednesday Please send me the following publications in the series on What Every Physician's Spouse American Academy of Medical night. Most of the psychiatric Should Know: Directors, Washington State Medical medications are very expensive. # of co p ies Association and the American Medical Consequently, we have an Impairment Professional Liability Association. outstanding pharmacy bill at St. Survival Tips for Resident Physician/ Joseph Hospital of over$8,500.00. Medical Student Spouses M arriage You have been generous Retirement and Estate Planning Advertise in contributors in the past and if there is (AVAILABLE FEB. 1, 1987) some way you could help us with our Each booklet is $3 per copy for AMA Auxiliary The Bulletin members and $5 per copy for non-members. current financial difficulties we would Enclosed is my check in the amount of For information certainly apprecaite it. $ ______made payable to the AMA Sincerely Auxiliary. Check must accompany order form call: Trudy Dodsworth NAME ______Barbara Goforth, ADDRESS 572-3709 Co-coordinator CITY/STATE/ZIP 's 8 The Bulletin November 1987 TELEPHONE ( )______j I______I AIDS and HIV Infection in Pierce County, Computerized Testing Sept. 25,1987 By Fastest Psychological, Vocational, A/DS Prevention Program Educat ional

Tacoma-Pierce County Health Department Adult and Children

The first case of Acquired here indicates that HIV in this Harold B. Johnston, MD, P.S. Immune Deficiency Syndrom (AIDS) community has moved into any other Allonmot'i' Medical Centor. in Pierce County was diagnosed in than the recognized high-risk groups: South IMlh & Union Tacom a, WA MMll.i 1983. Todaythere are 40 AIDS cases gay or bisexual men, IV drug users, or Telephone 38:3-2413 which met the Centers for Disease the sexual partners of members of Control definition of AIDS. However, those two groups. The future may these cases represent only a small present a different picture, however, fraction of the overall morbidity unless education efforts are successful at reducing high-risk caused by infection with the Human Featuring Immunodeficiency Vims (HIV). behavior. We have no good way to measure One arbitrary estimate used is that Tacoma's Finest Homes the extent of HIV infection in Pierce there may be 50 or 100 HIV-infected County. There are three main individuals in a community for every Richard C. Pessemier sources of information on the diagnosed case of AIDS. Even if this Sales Associate prevalence of seropositivity here: the is a great overestimate, it remains blood bank, the military and our own likely that there are hundreds, if not antibody testing in the AIDS thousands, of seropositive people in 272-41 ifl OPFICF 759-2699 H O M L PreventionProgram. None of these Pierce County. Swanson-McGoldrick, Inc. sources can be said to be Current estimates are that about IVAMHINl.lON HI imiNC, MU I I IUJ representative samples, however, one half of people infected with HIV TACUM4 WAMIINl'.TON MHJO; and so cannot be used as the basis may develop AIDS or other related forcommunity projections. symptoms within a five-year period, so Of over 60,000 units of blood by 1992 we can anticipate that there tested at Pierce County Blood Bank will be substantial numbers of people since May of 1985, only three have in our community with serious medical ^DIAPER RASH^ti proven positive with Western blot problems due to this virus. IS NOT A WAY OF LIFE confirmation. Testing of active-duty To report a case, please call the mi(ffary personnel in the Tacoma- AIDS Prevention Program at 591 - You can recommend professional Pierce County area reveals a Western 6060. □ diaper service w ith confidence. blot seropositivity rate of about 6 • Laboratory Controlled. Each month persons per 10,000. As of August * As of Sept. 21,1987 CDC had a random sample of our diapers is 10,1987, our program had performed received reports of 41,602 subjected to exhaustive studies in a antibody testing on 1135 samples of adult/adolescent cases of AIDS in the biochemical laboratory. blood, representing about 1100 United States. In addition, 580 • Utmost Convenience. Thanks to pick different individuals. Of those, 71 pediatric cases have been reported up and delivery service, our product were found positive by ELISA test, among persons underage 13, with a comes when you need it. confirmed through WEstern blot, total of deaths occuring in 24,245 or representing about 7% of the total. 58% of these cases. These data are •Economical. All this service, all this protection against diaper rash costs None of the evidence outlined provisonal. far less than paper diapers - only pennies more a day than home- Risk Group (Self Identification) Number Percent of Total washed diapers. CAUTION TO YOUR PATIENTS II is illegal to Gay/bisexual man 59 83 dispose of human excrement m garbage Parents are doing (his with paper/p'asfrc IV drug user (non-gay) 2 3 diapers "Disposable" is a misnomer Gay/bisexual and IV drug user 6 8 Sex contact of bisexual man 2 3 Sex contact of IV drug user 2 3

TACOMA WA TOLL FREE total 71 100 383-BABY 1-800-562-BABY Washington's Oldest. M ost Trusted Professional Diaper Service Serving Our Second Generation jT

19^7 Novtr.!1';- Vu ~i Personal Problem! of Physicians WSMA - At Your Service Committee For Imparied Physicians

Your colleagues want to help

Medical Problems, Drugs, Alcohol, Retirement, Emotional Problems The Monitored Treatment specimens are collected under direct Program which was formed by the observation by an approved monitor. Washington State Medical All participants attend weekly Committee Members Association in 1984 to help therapeutic group meetings of physicians suffering from chemical doctors. Othertherapies are Patrick Donley, Chairman 272-2234 dependency will move into its new scheduled on an individual basis. Robert A. O'Connell 627-2330 quarters at Cabrini Tower, Nov. 1987. Those participating in the John R. McDonough 572-2424 The program has achieved status program are asked to close as many as a non-profit corporation, the doors to relapse as possible. It is William A. McPhee 474-0751 Washington Monitored Treatment important that the spouse and other Ronald C. Johnson 841-4241 Program. Financial security for the significant family members, practice Jack P. Liewer 588-1759 corporation has been established, partners and sometimes the office, or with the WSMA sponsored S35857, hospital staff is informed of the Dennis F. Waldron 272-5127 enacted by the State Legislature and doctors participation in the program. Mrs. Marie Griffith 588-9371 signed by Governor Booth Gardner, The Washington Monitor WSMA: 1-800-522-7356 May 18,1987. This bill places a Treatment Programs confidential surcharge of up to $15.00 on each hotline remains the same, 1 -800-552- new or renewed medical license. 7236. □ The Washington Monitored Treatment Program allows for early indentification, intervention, and treatment of impaired physicians. It THE DOCTORS' EXCHANGE operates statewide for physicians, ENDORSED BY THE MEDICAL SOCIETY OF PIERCE COUNTY dentists, and veterinarians who suffer from chemical dependency. Each doctor entering the program signs a contract recognizing that he/she suffers from the disease of ...Another First alcoholism orchemical dependency. Specific recovery programs goals are outlined. Any doctor being Why settle for just monitored on a mandated will must a phone number? authorize regular reports to the mandating board, hospital or practice With the new group. Information The program also provides Display Pager advocacy to those in recovery who you can receive need support and direction in re­ patient name, establishing their professional nature of call credentials with the various boards, AND telephone No. hospitals and practice groups. INSTANTLY! Chemical monitoring of blood or urine specimens is done for all Office: 272-4111 participants on a regular and random Exchange: 272-3166 basis. Regular specimens are collected weekly. Random urine Locally owned and operated. and/or blood examinationss are performed on any individual who 908 Broadway, Suite 201 manifests significant behavioral Tacoma, WA 98402 changes suggestive or a relapse. All 10 Hie Bulletin November 1987 Maintenance Program, unless there is a medical risk in addition to drug \ Prescribing to Methadone Clients withdrawal, the individual shouid be refused the requested methadone ■ By Terry Reid, Substance Abuse Services Program Coordinator doses. On a weekend or holiday, it is i Tacoma-Pierce County Health Department not possible to coordinate with the Program treatment staff to confirm the individual’s status as a client on the At approximately 11 a.m. on physician to "administer (but not Program, proper dosage or indeed Saturday morning, an anxious young prescribe) narcotic drugs to a person even if the individual has missed the woman presents herself at a local for the purposes of relieving acute day’s dose. Therefore, it may be hospital emergency room stating she withdrawal symptoms when more of a risk to administer is in Methadone withdrawal after necessary while arrangements are methadone than merely to advise the missing her dose earlier in the day. being made for referral to treatment." individual that withdrawal is a very She won’t be able to obtain another Further, the regulation states, "Not uncomfortable but not life- dose until the program opens the more than one day’s medication may threatening condition. following Monday morning. She be administered to the person for the The Tacoma-Pierce County reports her dosage to be 40 mg. and person's use at any one time. Such Methadone Maintenance Program is requests a dose for both Saturday emergency treatment may be carried open from 6 a.m. to 4 p.m., Mon. and a take-home dose for Sunday, out for not more than three days and through Fri. Only the pharmacy is you call the Tacoma-Pierce County may not be renewed or extended." open on Sat. from 7 a.m. to 9 a.m., Methadone Maintenance Program This regulation does not pertain to and closed on Sun. and most only to discover that they are closed. Methadone in treatment of addiction holidays. The program has served So, with no way to confirm this and withdrawal as an incidental over400 individuals on an annual individual's status as a Methadone adjunct to medical or surgical basis and presently has openings for client, what should you do? conditions. treatment. The Program is located in There are several ways to review From the viewpoint of Richard the Health Department at 37th and this case. From a legal standpoint, Hawkins, MD, Medical Directorof the Pacific Avenue and can be reached DEA regulations (1306.07B allow the Tacoma-Pierce County Methadone by calling 591-6405. □ What’s new for physicians at St Joseph Hospital?

♦ A Se con d CT S c a n n e r is n o w is use. ♦ Cardiac Cath Laboratory offering This GE 8800 Scanner w ill help us per­ angioplasty procedures and heart form more procedures and reduce wait­ catheterizations. ing time for you and your patients This scanner supplements our state-of-the-art ♦ M obile Lithotripsy Unit for non-surgi- CT9800 Quick Scanner cal treatment of kidney stones. Litho­ tripsy van is available twice a month at ♦ Eating D isorder Center providing the hospital. treatment and education to help patients recover from anorexia, bulimia, compul­ sive overeating and other eating problems.

♦ Echocardiograph Color Doppler U ltrasound Machine. First in Fierce County. Provides a more detailed picture St. Joseph Hospital of the heart and a better indication of Caring Is Strong Medic hie, I bo. blood flow. l:ornioreinformation, call 591-6767.

19S7 iVA'emlxr The Bulletin ]1 Annual Meeting, Sept. 17-20. Tacoma, Washington.

Dr. Peter Marsh, MSPC Board Member and Delegate chaired reference committee' which dealt with many important issues, such as: physician advertising, Medical Quackery, Peer Review and others.

Dr. Ralph Johnson, Newly elected Presi­ dent of WSMA makes a statement at a MSPC Member and delegate representing the senior physician section, Dr. Richard reference committee meeting during the V im o n t g e ts a p o in t across to S tate S e n a to r P hil T a im a d g e , Jr., C hairm an of the State W S M A A nnu al M eeting. Senate Judiciary Committee.

Members of the MSPC Delegation watch the action on the floor of House of Delegates. M e m b e rs of the M S P C d e le g a tio n to th e W S M A H o u s e o f D elegates, L-R Drs. Ken They are: Drs. Gerald Anderson, Charles Bodily, Stan Tuell, Johann Duenhoelter, Bruce Smith W SMA Trustee Charles Wealherby, Tom Clark, Bill Jackson and Weatherby, Richard Vimont and Bill Marsh. Dave H opkins.

]2 t'hc Bulletin November 19H7 MSPC President Dr. Dick Bowe, Chairman of the W SMA Annual WSMA Trustee and MSPC member since 1981, Dr. Charles Meeting Site Committee Reports to the House of Delegates on the Weatherby addreses the WSMA House of Delegates on an Committees Selection. In the background is Vice S peaker Dr. issue before the house. Richard Hawkins, WSMA President, Dr. Rick Johnson and Mr. Tom Curry, W SM A Executive Director.

Immediate Past President of M SPC , Dr. Richard H aw kins and Dr. Ken Bodily, M S P C Vice President addresses the House of Vice Speaker of the House of Delegates is shown presiding D elegates on an issue of concern So him and the delegates. over the House. He received m any com plim ents fo r his knowledge of parlim entary procedure and conduct of meetings. 1937 November The Bulte.hr L-R MSPC President Dr. Dick Bowe, and Drs. Stan Tuell, Leonard Alenick and Eileen Toth Dr. James Krueger, MSPC Delegate study the WSMA House of Delegates Handbook during the four day meeting at the addresses the podium on an issue Tacoma-Sheraton Hotel. of concern.

More of the MSPC Delegation L-R Drs Peter Marsh Rill larkcnn Rnh ~ ■ W liiln o y and Ken B odily k e e p a w atch ful eye on the activities of th e ?!' I* ^ t0^T9!hef ®lnrthe u< nr o o' Dolf-'onte' Meeting. Susie co-chatred the Auxiliary s efforts for the ' '~'y meeting with Mrs.Helen Whitney. Pierce County Medical Society Auxiliary Members spent many hours during the four-day meeting handling registration. Hare we see L-R Mrs. Judy Donley, Helen Whitney, Barbara Talcott, Susie Duffy and Marilyn Bodily.

Raising funds for the AMA-ERF by selling Teddy Bears during the Annual Meeting were Auxiliary mem bers: Helen Whitney, Tacom a ^ary Skinner, Olympia; and Mary Randolph, Olympia.

K'S 7 N o v e m b e r Tfa. i l u l i d l n l: - Recommendations for Prevention of HIV Transmission in Health-Care Settings

Morbidity and Mortality Weekly Report (Supplement 2S) Centers for Disease Control, Atlanta

Reprinted from: JAMA, Sept. 11,1987, Vol 258 No 10- Sept. 18,1987, Vol 258, No. 11 ' ' '

INTRODUCTION also update portions of the 'Guideline Al DS patients initially reported as for Isolation Precautions in Hospitals'7 not belonging to recognized risk Human immunodeficiency virus and reemphasize some of the groups are investigated by state and (HIV), the virus that causes acquired recommendations contained in local health departments to determine immunodeficiency syndrome (AIDS), 'Infection Control Practices for whether possible risk factors exist. Of is transmitted through sexual contact Dentistry.'8 The recommendations all health-care workers with AIDS and exposure to infected blood or contained in this document have reported to CDC who were initially blood components and perinatally been developed for use in health­ characterized as not having an from mother to neonate. HIV has care settings and emphasize the identified risk and for whom follow-up been isolated from blood, semen, need to treat blood and other body information was available, 66% have vaginal secretions, saliva, tears, fluids from all patients as potentially been reclassified because risk factors breast milk, cerebrospinal fluid, infective. These same prudent were identified or because the patient amniotic fluid and urine and is likely to precautions also should be taken in was found not to meet the be isolated from other body fluids, other settings in which persons may surveillance case definition for AIDS. secretions and excretions. However, be exposed to blood or other body Of the 87 health-care workers epidemiologic evidence has fluids. currently categorized as having no implicated only blood, semen, vaginal identifiable risk, information is secretions and possibly breast milk in incomplete on 16 (18%) because of Definition of Health-Care Workers transmission. death or refusal to be interviewed; 38 Health-care workers are defined The increasing prevalence of HIV (44%) are still being investigated. as persons, including students and increases the risk that health-care The remaining 33 (38%) health-care workers will be exposed to blood from trainees, whose activities involve contact with patients or with blood or workers were interviewed or had patients infected with HIV, especially other follow-up information available. when blood and body-fluid other body fluids from patients in a health-care setting. The occupations of these 33 were as precautions are not followed for all follows: five physicians (15%), three patients. Thus, this document Health-Care Workers With AIDS of whom were surgeons; one dentist emphasizes the need for health-care (3%); three nurses (9%); nine nursing As of Ju ly 10,1987, a total of workers to consider all patients as assistants (27%); seven house­ 1,875 (5.8%) of 32,395 adults with potentially infected with HIV and/or keeping or maintenance workers AIDS, who had been reported to the other blood-borne pathogens and to (21%); three clinical laboratory CDC national surveillance system and adhere rigorously to intection-control technicians (9%); one therapist (3%); for whom occupational information precautions for minimizing the risk of and four others who did not have was available, reported being exposure to blood and body fluids of contact with patients (12%). Although employed in a health-care or clinical all patients. 15 of these 33 health-care workers laboratory setting. In comparison, 6.8 The recommendations contained reported parenteral a n d /o r other non- million persons - representing 5.6% in this document consolidate and needlestick exposure to blood or of the U.S. labor force - were update CDC recommendations body fluids from patients in the 10 employed in health services. Of the published earlierforpreventing HIV years preceding their diagnosis of health-care workers with AIDS, 95% transmission in health-care settings: AIDS, none of these exposures have been reported to exhibit high- precautions for clinical and laboratory i nvolved a patient with Al DS or known staffs1 and precautions for health­ risk behavior; forthe remaining 5%, HIV infections. care workers and allied the means of HIV acquisition was professionals* recommendations for undetermined. Health-care wooers Risk to Health-Care Workers of preventina HIV transmission in the with AIDS were significantly more Acquiring HIV in Health-Care Settings workplace-3 and during invasive likely than other workers to have an procedure;4 recommendations for undetermined risk (5% versus 3%, Health-care workers with preventing possible transmission of respectively). For both health-care documented percutaneous or HIV from tears;5 and workers and non-health-care workers mucous-membrane exposures to recommendations for providing with AIDS, the proportion with an blood or body fluids of HIV-infected dialysis treatment for HIV-infected undetermined risk has not increased patients have been prospectively since 1982. patients.6 These recommendations Continued on page 17. 16 The Bulletin November 1987 Prevention of H IV Transmission infected patients and denied other contact with blood or other body in Health-Care Setting, continued risk factors have been reported to fluids of any patient is anticipated. from p■ 16- have acquired HIV infection. Three of Gloves should be worn for touching evalu ated to determine the risk of these health-care workers had blood and body fluids, mucous infection after such exposures. As of needlestick exposures to blood from membranes, or non-intact skin of all June 30,1987,883 health-care infected patients.13'1^Two were patients, for handling items or workers have been tested for persons who provided nursing care to surfaces soiled with blood or body antibody to HIV in an ongoing infected persons; although neither fluids, and for performing surveillance project conducted by sustained a needlestick, both had venipuncture and other vascular CDC.9 Of these, 708 (80%) had extensive contact with blood or other access procedures. Gloves should percutaneous exposures to blood, body fluids, and neither observed be changed after contact with each and 175 (20%) had a mucous recommended barrier patient. Masks and protective membrane or an open wound precautions.16'1' The otherthree eyewear or face shields should be contaminated by blood or body fluid. were health-care workers with non- worn during procedures that are likely 0> 396 health-care workers, each of needlestick exposures to blood from to generate droplets of blood or olher whom had only a convalescent-phase infected patients.18 Although the body fluids to prevent exposure of serum sample obtained and tested exact route of transmission forthese mucous membranes of mouth, nose greaterthan or equal to 90 days post­ last three infections is not known, all and eyes. Gowns or aprons should exposure, one - for whom three persons had direct contact of be worn during procedures that are heterosexual transmission could not their skin with blood from infected likely to generate splashes of blood or be ailed out - was seropositive for HIV patients, all had skin lesions that may other body fluids. antibody. For 425 additional health­ have been contaminated by blood, 2. Hands and other skin surfaces care workers, both acute- and and one also had a mucous- should be washed immediately and convalescent-phase serum samples membrane exposure. thoroughly if contaminated with blood were obtained and tested; none of 74 A total of 1,231 dentists and or other body fluids. Hands should health-care workers with hygienists, many of whom practiced in be washed immediately after gloves nonpercutaneous exposures areas with many AIDS cases, are removed. seroconverted, and three (0.9%) of participated in a study to determine 3. All health-care workers should 351 with percutaneous exposures the prevalence of antibody to HIV; take precautions to prevent injuries seroconverted. None of these three one dentist (0.1%) had HIV antibody. caused by needles, scalpels and health-care workers had other Although no exposure to a known other sharp instruments ordevices documented risk factors for infection. HIV-infected person could be during procedures; when cleaning Two other prospective studies to documented, epidemiologic used instruments; during disposal of assess the risk of nosocomial investigation did not identify any used needles; and when handling acquisition of HIV infection for health­ otherriskfactorforinfection. The sharp instruments after procedures. care workers are ongoing in the infected dentist, who also had a To prevent needlestick injuries, United States. As of April 30,1987, history of sustaining needlestick needles should not be recapped, 332 health-care workers with a total of injuries and trauma to his hands, did purposely bent or broken by hand, 453 needlestick or mucous- not routinely wear gloves when removed from disposable syringes, or membrane exposures to the blood or providing dental care.19 otherwise manipulated by hand. After they are used, disposable syringes other body fluids of HIV-infected and needles, scalpel blades and patients were tested for HIV antibodv Precautions to Prevent Transmission other sharp items should be placed in at the National Institutes of Health.10 of HIV puncture-resistant containers for These exposed workers included Universal Precautions disposal; the puncture-resistant 103 with needlestick injuries and 229 Since medical history and containers should be located as close with mucous-membrane exposures; examination cannot reliably identify all as practical to the use area. Large- none had seroconverted. A similar patients infected with HIV or other bore reusable needles should be study at the University of California of blood-borne pathogens, blood and placed in a puncture-resistant 129 health-care workers with body-fluid precautions should be container for transport to the documented needlestick injuries or consistently used for all patients. This reprocessing area. mucous-membrane exposures to approach,previously recommended 4. Although saliva has not been blood or other body fluids from by CDC,3'^and referred to as implicated in HIV transmission, to patients with HIV infection has not 'universal blood and body-fluid minimize the need for emergency identified any seroconversions.11 precautions' or 'universal mouth-to-mouth resuscitation, Results of a prospective study in the precautions,' should be used in the mouthpieces, resuscitation bags, or United Kingdom identified no care of all patients, especially other ventilation devices should be evidence of transmission among 150 including those in emergency-care available for use in areas in which the health-care workers with parenteral or settings in which the risk of blood need for resuscitation is predictable. mucous-membrane exposures to exposure is increased and the 5. Health-care workers who have blood or other body fluids, infection status of the patient is exudative lesions or weeping secretions, or excretions from usually unknown.20 dermatitis should refrain from all direct patients with HIV infection.1^ 1. All health-care workers should patient care and from handling patient- In addition to health-care workers routinely use appropriate barrier care equipment until the condition enrolled in prospective studies, eight precautions to prevent skin and resolves. continued on pa^e ]S. mucous-membrane exposure when persons who provided care to 19S7 November The Bulletin 17 Prevention of HIV Transmission the generation of droplets, splashing and air/water syringes. in Health-Care Settings from p.17 of blood or other body fluids, orthe 3. Blood and saliva should be generation of bone chips. Gowns or 6. Pregnant heatth-care workers thoroughly and carefully cleaned from aprons made of materials that provide are not known to be at greater risk of material that has been used in the contracting HIV infection than health­ an effective barrier should be worn mouth (e.g., impression materials, during invasive procedures that are care workers who are not pregnant; bite registration), especially before however, if a health-care worker likely to result in splashing of blood or polishing and grinding intra-oral develops HIV infection during other body fluids. All health-care devices. Contaminated materials, workers who perform of assist in pregnancy, the infant is at risk of impressions, and intra-oral devices infection resulting from perinatal vaginal or cesarean deliveries should should also be cleaned and transmission. Because of this risk, wear gloves and gowns when disinfected before being handled in pregnant health-care workers should handling the placenta orthe infant the dental laboratory and before they be especially familiar with and strictly until blood and amniotic fluid have are placed in the patient's mouth. adhere to precautions to minimize the been removed from the infant's skin Because of the increasing variety of risk of HIV transmission. and should wear gloves during post­ dental materials used intra-orally, Implementation of universal delivery care of the umbilical cord. dental workers should consult with blood and body-fluid precautions for 2. If a glove is tom or a manufacturers as to the stability of all patients eliminates the need for needlestick or other injury occurs, the specific materials when using use of the isolation category of 'Blood glove should be removed and a new disinfection procedures. and Body Fluid Precautions' glove used as promptly as patient 4. Dental equipment and previously recommended by CDC' safety permits; the needle or surfaces that are difficult to disinfect for patients known or suspected to be instrument involved in the incident (e.g., light handles or X-ray-unit infected with blood-borne should also be removed from the heads) and that may become pathogens. Isolation precautions sterile field. contaminated should be wrapped (e.g., enteric, AFB?) should be used with impervious-backed paper, as necessary if associated conditions, Precautions for Dentistry* aluminum foil or clear plastic wrap. The such as infectious diarrhea or Blood, saliva and gingival fluid coverings should be removed and tuberculosis, are diagnosed or from all dental patients should be discarded, and clean coverings suspected. considered infective. Special should be put in place after use with emphasis should be placed on the each patient. Precautions for Invasive following precautions for preventing Procedures transmission of blood-borne Precautions for Autopsies or In this document, an invasive pathogens in dental practice in both Morticians' Services procedure is defined as surgical entry institutional and non-institutional In addition to the universal blood into tissues, cavities, or organs or settings. and body-fluid precautions listed repair of major traumatic injuries 1) in 1. In addition to wearing gloves above, the following precautions an operating or delivery room, for contact with oral mucous should be used by persons emergency department, or outpatient membranes of all patients, all dental performing postmortem procedures: setting, including both physicians' workers should wear surgical masks 1. All persons performing or and dentists'; offices; 2) cardiac and protective eyewearorchin-length assisting in postmortem procedures catheterization and angiographic plastic face shields during dental should wear gloves, masks, procedures; 3) a vaginal or cesarean procedures in which splashing or protective eyewear, gowns and delivery or other invasive obstetric spattering of blood, saliva or gingival waterproof aprons. procedure during which bleeding may fluids is likely. Rubber dams, high­ 2. Instruments and surfaces occur; or 4) the manipulation, cutting, speed evacuation and proper patient contaminated during postmortem or removal of any oral or perioral positioning, when appropriate, procedures should be tissues, including tooth structure, should be utilized to minimize decontaminated with an appropriate during which bleeding occurs or the generation of droplets and spatter. chemical germicide. potential for bleeding exists. The 2. Handpieces should be universal blood and body-fluid sterilized after use with each patient, Precautions for Dialysis precautions listed above, combined since blood, saliva or gingival fluid of Patients with end-stage renal with the precautions listed below, patients may be aspirated into the disease who are undergoing should be the minimum precautions handpiece or waterline. Handpieces maintenance dialysis and who have for all such invasive procedures. that cannot be sterilized should at 1. All health-care workers who HIV infection can be dialyzed in least be flushed, the outside surface hospital-based or free-standing participate in invasive procedures cleaned and wiped with a suitable must routinely use appropriate barrier dialysis units using conventional chemical germicide, and then rinsed. infection-control precautions/ precautions to prevent skin and Handpieces should be flushed at the Universal blood and body-fluid mucous-membrane contact with beginning of the day and after use precautions should be used when blood and other body fluids of all with each patient. Manufacturers' patients. Gloves and surgical masks dialyzing all patients. recommendations should be followed Strategies for disinfecting the must be worn for all invasive for use and maintenance of waterlines procedures. Protective eyewear or dialysis fluid pathways of the and check valves and for flushing of hemodialysis machine are targeted to face shields should be worn for handpieces. The same precautions procedures that commonly result in should be used for ultrasonic scalers Continued on page 19-

18 The Built: lux November 1987 Prevention of HIV Transmissions or microbiologic culturing, a biological care equipment currently in a Health-Care Setting continued safety cabinet is necessary. recommended for use " , 26 ,n a from p■ 18. However, biological safety cabinets variety of heatth-care settings- control bacterial contamination and (Class I or II) should be used including hospitals, medical and generally consist of using 500-750 whenever procedures are conducted dental clinics and offices, parts per million (ppm) of sodium that have a high potential for hemodialysis centers, emergency- hypochlorite (household bleach) for generating droplets. These include care facilities, and long-term nursing- 30-40 minutes or l.5%-2.0% activities such as blending, care facilities—are adequate to sterilize formaldehyde overnight. In addition, sonicating, and vigorous mixing. or disinfect instruments, devices, or several chemical germicides 4. Mechanical pipetting devices other items contaminated with blood formulated to disinfect dialysis should be used for manipulating all or other body fluids from persons machines are commercially available. liquids in the laboratory. Mouth infected with blood-borne pathogens None of these protocols or pipetting must not be done. including HIV. 21 >23 procedures need to be changed for '5. Use of needles and syringes Instruments or devices that enter dialyzing patients infected with HIV. should be limited to situations in sterile tissue orthe vascular system of Patients infected with HIV can be which there is no alternative, and the any patient orthrough which bfood dialyzed by either hemodialysis or recommendations for preventing flows should be sterilized before peritoneal dialysis and do not need to injuries with needles outlined under reuse. Devices or items that contact beisolatedfromotherpatients. The universal precautions should be intact mucous membranes should be type of dialysis treatment (i.e., followed. sterilized or receive high-level hemodialysis orperitoneal dialysis) 6. Laboratory would surfaces disinfection, a procedure that kills should be based on the needs of the should be decontaminated with an vegetative organisms and viruses but patient. Thedialyzermaybe appropriate chemical germicide after a not necessarily large numbers of discarded after each use. spill of blood or other body fluids and bacterial spores. Chemical Alternatively, centers that reuse when work activities are completed. germicides that are registered with diaiyzers, i.e., a specific singfe-user 7. Contaminatedmaterialsused the U.S. Environmental Protection dialyzer is issued to a specific patient, in laboratory tests should be Agency (EPA) as ‘sterilants’ may be removed, cleaned, disinfected, and decontaminated before reprocessing used either tor sterilization or for high- reused several times on the same or be placed in bags and disposed of level disinfection depending on patient only, may include HIV-infected in accordance with institutional contact time. patients in the dialyzer-reuse policies for disposal of infective Contact lenses used in trial program. An individual dialyzermust waste.24 fittings should be disinfected after never be used on more than one 8. Scientific equipment that has each fitting by using a hydrogen patient. been contaminated with blood or peroxide contact lens disinfecting other body fluids should be system or, if compatible, with heat Precautions for Laboratories’ * decontaminated and cleaned before (78°C-80°C (172.4° F-176.0° F) for 10 Blood and other body fluids from being repaired in the laboratory or minutes. all patients should be considered transported to the manufacturer. Medical devices or instruments infective. To supplement the 9. All persons should wash their that require sterilization ordisinfection universal blood and body-fluid hands after completing laboratory should be thoroughly cleaned before precautions listed above, the activities and should remove being exposed to the germicide, and following precautions are protective clothing before leaving the the manufacturer's instructions tor the recommended for health-care laboratory. use of the germicide should be workers in clinical laboratories. Implementation of universal followed. Further, it is important that 1. All specimens of blood and blood and body-fluid precautions for the manufacturer's specifications for body fluids should be put in a well- all patients eliminates the need for compatibility of the medical device constructed containerwith a secure warning labels on specimens since with chemical germicides be closely lid to prevent leaking during transport. blood and other body fluids from al followed. Information on specific label Care should be taken when collecting patients should be considered claims of commercial germicides can each specimen to avoid infective. be obtained by writing to the contaminating the outside of the Disinfectants Branch, Office of container and of the laboratory form Pesticides, Environmental Protection Agency, 401 M Street, SW, accompany the specimen. Environmental considerations for Washington, DC 20460. 2. All persons processing blood HIV Transmission Studies have shown that HIV is and body-fluid specimens (e.g., inactivated rapidly after being removing tops from vacuum tubes) No environmentally mediated exposed to commonly used chemical should wear gloves. Masks and mode of HIV transmission has been germicides at concentrations that are protective eyewear should be worn if documented. Nevertheless, the much lowerthan used in mucous-membrane contact with precautions described below should practice.2'E m b a lm in g fluids are blood or body fluids is anticipated. be taken routinely in the care of all patients. similar to the types of chemical Gloves should be changed and germicides that have been tested and handswashed after completion of found to completely inactivate HIV. in specimen processing. Sterilization and Disinfection addition to commercially available 3. For routine procedures, such Standard sterilization and as histologic and pathologic studies disinfection procedures for patient- Continued on page 20.

ot'ci i987 ' “•* Bulletin l y Prevention of HIV Transmission changes in published procedures for cleaning, then decontaminated with in Health-Care Settings, continued cleaning, disinfecting, or sterilizing fresh germicidal chemical. In both from p. 19. need to be made. settings, gloves should be worn during the cleaning and chemical germicides, a solution of Housekeeping sodium hypochlorite (household Environmental surfaces such as decontaminating procedures. Laundry bleach) prepared daily is an walls, floors and other surfaces are inexpensive and effective germicide. not associated with transmission of Although soiled linen has been Concentrations ranging from infections to patients or health-care identified as a source of large workers. Therefore, extraordinary approximately 500 ppm (1:100 numbers of certain pathogenic dilution of household bleach) sodium attempts to disinfect or sterilize these microorganisms, the risk of actual hypochlorite to 5,000 ppm (1:10 environmental surfaces are not disease transmission is negligible. dilution of household bleach) are necessary. However, cleaning and Ratherthan rigid procedures and effective depending on the amount removal of soil should be done specifications, hygienic and common- of organic material (e.g., blood, routinely. sense storage and processing of mucus) present on the surface to be Cleaning schedules and clean and soiled linen are cleaned and disinfected. methods vary according to the area of recommended.26 Soiled linen Commercially available chemical the hospital or institution, type of should be handled as little as possible germicides may be more compatible surface to be cleaned, and the and with minimum agitation to prevent with certain medical devices that amount and type of soil present. gross microbial contamination of the might be corroded by repeated Horizontal surfaces (e.g., bedside air and of persons handling the linen. exposure to sodium hypochlorite, tables and hard-surfaced flooring) in All soiled linen should be bagged at especially to the 1:10 dilution. patient-care areas are usually cleaned the location where it was used; it on a regular basis, when soiling or should not be sorted or rinsed in Survival of HIV in the Environment spills occur, and when a patient is patient-care areas. Linen soiled with The most extensive study on the discharged. Cleaning of walls, blinds blood or body fluids should be placed survival of HIV after drying involved and curtains is recommended only if and transported in bags that prevent greatly concentrated HIV samples, they are visibly soiled. Disinfectant leakage. If hot water is used, linen i.e., 10 million tissue-culture fogging is an unsatisfactory method should be washed with detergent in infectious doses per milliliter.31 This of decontaminating air and surfaces water at least 71 ° C (160° F) for 25 concentration is at least 100,000 and is not recommended. minutes. If low-temperature (lessthan times greater than that typically found Disinfectant-detergent or equal to 70° C (158° F) laundry in the blood or serum of patients with formulations registered by EPA can cycles are used, chemicals suitable HIV infection. HIV was detectable by be used for cleaning environmental for low-temperature washing at proper tissue-culture techniques 1-3 days surfaces, but the actual physical use concentration should be used. after drying, but the rate of removal of micro-organisms by scrubbing is probably at least as inactivation was rapid. Studies Infective Waste performed at CDC have also shown important as any antimicrobial effect of There is no epidemiologic that drying HIV causes a rapid (within the cleaning agent used. Therefore, evidence to suggest that most several hours) 1-2 log (90%-99%) cost, safety, and acceptability by hospital waste is any more infective reduction in HIV concentration. In housekeepers can be the main criteria for selecting any such than residential waste. Moreover, tissue-culture fluid, cell-free HIV could there is no epidemiologic evidence be detected up to 15 days at room registered agent. The manufacturers' that hospital waste has caused temperature, up to 11 days at 37°C instructions for appropriate use disease in the community as a result (98.6°F), and up to 1 day if the HIV should be followed. of improper disposal. Therefore, was cell-associated. Cleaning and Decontaminating Spills identifying wastes for which special When considered in the context of Blood or Other Body Fluids precautions are indicated is largely a of environmental conditions in health­ Chemical germicides that are approved for use as 'hospital matter of judgment about the relative care facilities, these results do not risk of disease transmission. The require any changes in currently disinfectants' and are tuberculocidal most practical approach to the recommended sterilization, when used at recommended dilutions management of infective waste is to disinfection, or house-keeping can be used to decontaminate spills identify those wastes with the strategies. When medical devices are of blood and other body fluids. potential for causing infection during contaminated with blood or other Strategies for decontaminating spills handling and disposal and for which body fluids, existing of blood and other body fluids in a patient-care setting are different than some special precautions appear recommendations include the prudent. Hospital wastes for which cleaning of these instruments, for spills of cultures or other materials special precautions appear prudent followed by disinfection or in clinical, public health, or research include microbiology laboratory sterilization, depending on the type laboratories. In patient-care areas, waste, pathology waste, and blood of medical device. These protocols visible material should first be specimens or blood products. While assume "worst-case" conditions of removed and then the area should be any item that has had contact with extreme virologic and microbiologic decontaminated. With large spills of blood, exudates, or secretions may contamination, and whether viruses cultured or concentrated infectious have been inactivated after drying agents in the laboratory, the be potentially infective, it is not plays no role in formulating these contaminated area should be flooded usually considered practical or strategies. Consequently, no with a liquid germicide before Continued on page 21. 20 The Bulletin November 1987 Prevention of H IV Transmission when they are performed under management, and 3) counseling and in Health-Care Settings, continued optimal laboratory conditions on serologic testing to prevent and from p- 20. serum specimens from persons control HIV transmission in the infected for greater than or equal to community. In addition, more recent necessary to treat all such waste as 12 weeks. Optimal laboratory recommendations have stated that infective.23’26 Infective waste, in conditions include the use of reliable hospitals, in conjunction with state general, should either be incinerated reagents, provision of continuing and local health departments, should or should be autoclaved before education of personnel, quality periodically determine the prevalence disposal in a sanitary landfill. Bulk control of procedures, and of HIV infection among patients from blood, suctioned fluids, excretions, participation in performance- age groups at highest risk of and secretions may be carefully infection.'32 poured down a drain connected to a evaluation programs. Given this Adherence to universal blood sanitary sewer. Sanitary sewers may performance, the probability of a false- negative test is remote except during and body-fluid precautions also be used to dispose of other the first several weeks after infection, recommended for the care of all infectious wastes capable of being before detectable antibody is patients will minimize the risk of ground and flushed into the sewer. present. The proportion of infected transmission of HIV and other blood- persons with a false-negative test borne pathogens from patients to Implementation of Recommended attributed to absence of antibody in health-care workers. The utility of Precautions the early stages of infection is routine HIV serologic testing of dependent on both the incidence patients as an adjunct to universal Employers of health-care workers and prevalence of HIV infection in a precautions is unknown. Results of should ensure that policies exist for: population (Tablel). such testing may not be available in 1. Initial orientation and The specificity of the currently emergency or outpatient settings. In continuing education and training of licensed EIA tests is approximately addition, some recently infected all health-care workers - including 99% when repeatedly reactive tests patients will not have detectable students and trainees - on the are considered. Repeat testing of antibody to HIV (Table 1). epidemiology, modes of initially reactive specimens by EIA is Personnel in some hospitals transmission, and prevention of HIV required to reduce the likelihood of have advocated serologic testing of and other blood-borne infections and laboratory error. To increase further patients in settings in which exposure the need for routine use of universal the specificity of serologic tests, of health-care workers to large blood and body-fluid precautions for laboratories must use a supplemental amounts of patients' blood may be all patients. test, most often the Western blot, to anticipated. Specific patients for 2. Provision of equipment and validate repeatedly reactive EIA whom serologic testing has been supplies necessary to minimize the results. Under optimal laboratory advocated include those undergoing risk of infection with HIV and other conditions, the sensitivity of the major operative procedures and blood-borne pathogens. Western blot test is comparable to or those undergoing treatment in critical- 3. Monitoring adherence to greater than that of a repeatedly care units, especially if they have recommended protective measures. reactive EIA, and the Western blot is conditions involving uncontrolled When monitoring reveals a failure to highly specific when strict criteria are bleeding. Decisions regarding the follow recommended precautions, used to interpret the test results. The need to establish testing programs for counseling, education, and/or re­ testing sequence of a repeatedly patients should be made by training should be provided, and, if reactive EIA and a positive Western physicians or individual institutions. In necessary, appropriate disciplinary blot test is highly predictive of HIV addition, when deemed appropriate, action should be considered. infection, even in a population with a testing of individual patients may be Professional associations and low prevalence of infection (Table 2). performed on agreement between labororganizations, through If the Western blot test result is the patient and the physician continuing education efforts, should indeterminant, the testing sequence providing care. emphasize the need for health-care is considered equivocal for HIV In addition to the universal workers to follow recommended infection. When this occurs, the precautions recommended for all precautions. Western blot test should be repeated patients, certain additional on the same serum sample, and, if still precautions for the care of HI V- Serologic Testing for HIV Infection indeterminant, the testing sequence infected patients undergoing major should be repeated on a sample surgical operations have been Background collected 3-6 months later. Use of proposed by personnel in some A person is identified as infected other supplemental tests may aid in hospitals. For example, surgical with HIV when a sequence of tests, interpreting results on samples that procedures on an HIV-infected starting with repeated enzyme are persistently indeterminant by patient might be altered so that had-to- immunoassays (EIA) and including a Western blot. hand passing of sharp instruments Western blot or similar, more specific Testing of Patients would be eliminated; stapling assay, are repeatedly active. Persons Previous CDC recommendations instruments ratherthan hand-suturing infected with HIV usually develop have emphasized the value of HIV equipment might be used to perform antibody against the virus within 6-12 serologic testing of patients for: 1) tissue approximation; electrocautery devices ratherthan scalpels might be weeks after infection. management of parenteral or mucous- used as cutting instruments; and, The sensitivity of the currently membrane exposures of health-care licensed EIA tests is at least 99% workers, 2) patient diagnosis and Conlinued on page 22. November 1987 The bulletin 21 Prevention of HIV Transmission contaminate instruments or open associated with taking care of patients in Health-Care Settings, wounds of patients.33-34 with any transmissible infection and continued from p. 21. The hepatitis B experience should continue to follow existing even though uncomfortable, gowns indicates that only those health-care recommendations for infection that totally prevent seepage of blood workers who perform certain types of control to minimize risk of exposure to onto the skin of members of the invasive procedures have transmitted other infectious agents/’3^ operative team might be worn. While HBV to patients. Adherence to Recommendations of the such modifications might further recommendations in this document Immunization Practices Advisory minimize the risk of HIV infection for will minimize the risk of transmission of Committee (ACIP) and institutional members of the operative team, some HIV and other blood-borne policies concerning requirements for of these techniques could result in pathogens from health-care workers vaccinating health-care workers with prolongation of operative time and to patients during invasive live-virus vaccines (e.g. measles, could potentially have an adverse procedures. Since transmission of rubella) should also be considered. effect on the patient. HIV from infected health-care workers The question of whether workers Testing programs, if developed, performing invasive procedures to infected with HIV - especially those should include the following their patients has not been reported who perform invasive procedures - principles; and would be expected to occur only can adequately and safely be allowed • Obtaining consent for testing. very rarely, if at all, the utility of routine to perform patient-care duties or • Informing patients of test results, testing of such health-care workers to whether their work assignments and providing counseling for prevent transmission of HIV cannot should be changed must be seropositive patients by properly be assessed. If consideration is given determined on an individual basis. trained persons. to developing a serologic testing These decisions should be made by • Assuring that confidentiality program for health-care workers who the health-care worker's personal safeguards are in place to limit perform invasive procedures, the physician(s) in conjunction with the knowledge of test results to those frequency of testing, as well as the medical directors and personnel directly involved in the care of issues of consent, confidentiality, and health service staff of the employing infected patients or as required by consequences of test results - as institution or hospital. law. previously outlined for testing Management of Exposures programs for patients - must be • Assuring that identification of If a health-care worker has a addressed. infected patients will not result in parenteral (e.g. needlestick or cut) or denial of needed care or provision of mucous-membrane (e.g. splash to Management of Infected Health-Care suboptimal care. the eye or mouth) exposure to blood Workers • Evaluating prospectively 1) the or other body fluids or has a Health-care workers with impaired efficacy of the program in reducing cutaneous exposure involving large immune systems resulting from HIV the incidence of parenteral, mucous- amounts of blood or prolonged infection or other causes are at membrane, or significant cutaneous contact with blood - especially when increased risk of acquiring or exposures of health-care workers to the exposed skin is chapped, experiencing serious complications of the blood or other body fluids of HIV- abraded, or afflicted with dermatitis - infectious disease. Of particular infected patients and 2) the effect of the source patient should be concern is the risk of severe infection modified procedures on patients. informed of the incident and tested Testing of Health Care Workers following exposure to patients with for serologic evidence of HIV Although transmission of HIV infectious diseases that are easily infection after consent is obtained. from infected health-care workers to transmitted if appropriate precautions Policies should be developed for are not taken (e.g. measles, varicella). patients has not been reported, testing source patients in situations in transmission during invasive Any health-care worker with an which consent cannot be obtained procedures remains a possibility. impaired immune system should be Transmission of hepatitis B virus counseled about the potential risk Continued on page 23. (HBV) - a blood-borne agent with a Table 1. Estimated annual numberof patients infected with HIV not detected considerably greater potential for by HI V-antibodt testing in a hypothetical hospital with 10,000 admissions/year* nosocomial spread - from health-care workers to patients has been Approximate Approximate number documented. Such transmission has Beginning Annual num berof of HIV-infected prevalence of incidence of HIV-infected patients occurred in situations (e.g. oral and HIV Infection HIV infection patients not detected gynecologic surgery) in which health­ care workers, when tested, had very 5.0% 1.0% 550 17-18 high concentrations of HBV in their 5.0% 0.5% 525 11-12 blood (at least 100 million infectious 1.0% 0.2% 110 3-4 1.0% 0.1% 105 2-3 virus particles per milliliter, a 1/0% 0.02% 11 0-1 concentration much higher than 0.1% 0.01% 11 0-1 occurs with HIV infection), and the health-care workers sustained a The estimates are based on the following assumptions: 1) the sensitivity of the screening testis puncture wound while performing 99% (i.e., 99% of HIV-infected persons with antibody will be detected; 2) persons infected with HIV invasive procedures or had exudative will not develop detectable antibody (seroconvert) until 6 weeks (1.5 months) after infection; 3) new infections occur at equal rate throughout the year; 4) calculations of the numberof HIV- orweeping lesions or infected persons in the patient population are based on the mid-year prevalence, which is the microlacerations that allowed virus to beginning prevalence plus half the annual incidence of infections. 22 The Bulletin November 1987 Prevention of HTV Transmission in Health-Care Settings, continued front p. 22. (e.g. an unconscious patient). Allenmore It the source patient has AIDS, is positive for HIV antibody, or refuses the test, the health-care worker should be counseled regarding the Medical Center risk of infection and evaluated clinically and serologically for evidence of HIV infection as soon as Pierce County’s most prestigious medical/dental facility. possible afterthe exposure. The 22 acre campus adjacent to the 156 bed Humana Hospital, health-care worker should be advised Tacoma. Central location, easy freeway access. All inclusive to report and seek medical evaluation rental rates with suite construction allowances available. for any acute febrile illness that occurs within 12 weeks after the exposure. Such an illness - particularly one • Limited number of medical/dental characterized by fever, rash or suites now available lymphadenopathy - may be indicative of recent HIV infection. Seronegative health-care workers should be retested 6 weeks post-exposure and (206) 383-2201 on a periodic basis thereafter (e.g. 12 (206) 383-2086 weeks and 6 months after exposure) to determine whether transmission hasoccurred. During this follow-up period - especially the first 6-12 weeks after exposure, when most Julie Labrecque, CPM, Business Manager infected persons are expected to S. 19th & Union • Suite B-1005 • Tacoma, WA 98405 seroconvert - exposed health-care workers should follow U.S. Public Health Service (PHS) recommendations forpreventing transmission of HIV.36,37 No further follow-up of a health­ ‘‘When Grandpa got sick, 1 asked my Dad if I could go visit him at Manor Care care worker exposed to infection as where he's staying till he gets better. You see, it's really important, because I’m the described above is necessary it the family fisherman while Gramps is gone, and I come here every week to tell him source patient is seronegative unless how many fishes 1 caught" the source patient is at high risk of HIV 'I really like visiting Gramps at his place. Because they always let me see him. infection. Inthe latter case, a no matter when I come. And the people here always give us good snacks - subsequent specimen (e.g. 12 almost as good as the fish fry we’re going to have when Gramps comes home." weeks following exposure) may be “But mostly 1 like it here at Manor Care because my Grandpa does . . . and obtained from the health-care worker that’s the most important thing of all." forantibodytesling. If the source patient cannot be identified, decisions regarding appropriate Manor Care of Meadow Park follow-up should be individualized. CONVALESCENT AND REHABILITATION CENTER 56 0 1 S. Orchard St. • Tacoma • 474-8 4 21 Serologic testing should be available io all health-care workers who are Medicare Certified concerned that they may have been infected with HIV. If a patient has a parenteral or mucous-membrane exposure to ‘I Told Gramps blood or other body fluid of a health­ care worker, the patient should be About The informed of the incident, and the same procedure outlined above for One That management of exposures should be Got Away.” followed for both the source health­ care worker and the exposed patient, ‘General infection-control precautions are wore specifically addressed in previous recommendations for infection-control practices for dentistryP 'Additional precautions for research and industrial laboratories are addressed elsewhere??^ O Prevention of HIV Transmission 19. Kline RS, Phelan J, Friedland GH, et al. agency recommendations. MMWR Low occupational risk for HIV infection for 1983:32:101-3. in Health-Care Settings continued. dental professionals (Abstract). In: Abstracts 37. CDC. Provisional Public Health Service References from the III International Conference on AIDS, interagency recommendations for screening 1. CDC. Acquired immunodeficiency syndrome 1-5 June 1985, Washington, DC:155. donated blood and plasma for antibody to the (AIDS): Precautions for clinical and laboratory 20. Baker JL, Kelen GD, Sivertson KT, Quinn virus causing acquired immunodeficiency staffs. MMWR 1982;31:577-80. TC. Unsuspected human immunodeficiency syndrome. MMWR 1985;34:1-5. 2. CDC. Acquired immunodeficiency syndrome virus in critically ill emergency patients. JAMA (Al DS): Precautions for health-care workers 1987;257:2609-11. and allied professionals. MMWR 1983; 32:450- 21. FaveroMS. Dialysis-associated diseases 1. and their control. In: Bennett JV, Brachman 3. CDC. Recommendations for preventing PS, eds. Hospital infections. Boston: Little, transmission of infection with human T- Brown and Company, 1985:267-84. lymphotropic vims type lll/lymphadenopathy- 22. Richardson JH, Barkley WE, eds. associated virus in the workplace. MMWR Biosafety in microbiological and biomedical 1985;34:681-6,691-5. laboratories, 1984. Washington, DC: US 4. CDC. Recommendations for preventing Department of Health and Human Services, transmission of infection with human T- Public Health Service. HHS publication no. lymphotropic virus type lll/lymphadenopathy- (CDC) 84-8395. associated virus during invasive procedures. 23. CDC. Human T-lymphotropic virus type RARE COINS MMWR 1986;35:221-3. lll/lym phadenopathy- 5. CDC. Recommendations for preventing associated virus: Agent summary statement. MAKE MONEY possible transmission of human T-lymphotropic MMWR 1986;35:540-2,547-9. virus type lll/lymphadenopathy-associated 24. Environmental Protection Agency. EPA FOR OUR CLIENTS... virus from tears. MMWR 1985:34:533-4. guide for infectious waste management. 6. CDC. Recommendations for providing Washington, DC: U.S. Environmental dialysis treatment to patients infected with Protection Agency, May 1986 (Publication no. human T-lymphotropic virus type EPA/530-SW-86-014). lll/lymphadenopathy-associated virus 25. Favero MS. Sterilization, disinfection, and During rhe posr 10 years rare coins infection. MMWR 1986; 35:376-8,383. antisepsis in the hospital. In: Manual of hove outpaced oil, gold, silver, 7. Garner JS, Simmons BP. Guideline for clinical microbiology. 4th ed. Washington, DC: d ia m o n d s , e v e n real esrore, os a isolation precautions in hospitals. Infect American Society for Microbiology; 1985; 129- superior mvesrmenr averaging Control 1983; 4 (suppl): 245-325. 37. 8. CDC. Recommended infection control over 20% annual appreciation 26. Gamer JS, Favero MS. Guideline for practices for dentistry. MMWR 1986;35:237- If you'd like more information handwashing and hospital environmental 42. regording building your own, personal control, 1985. Atlanta: Public Health Service, 9. McCray E, The Cooperative Needlestick Centers for Disease Control, 1985. HHS rore com portfolio please give me a Surveillance Group. Oixupational risk of the publication no. 99-1117. coll acquired immunodeficiency syndrome among 27. Spire B. Montagnier L. Barre-Sinoussi F, health care workers. N Engl J Med 1986; Here ar HRCI we guaranree whar Chermann JC. Inactivation of 314:1127-32. we sell, and, wherher you're a new lymphadenopathy associated virus by 10. Henderson DK, Saah AJ, Zak BJ, etal. mvesror or a seasoned professional we chemical disinfectants. Lancet 1984;2:889- Risk of nosocomial infection with human T-cell offer: 901. lymphotropic virus type lll/lymphadenopathy- 28. Martin LS, McDougal JS. Marlin LS, Cort ■ INSTANT LIQUIDITY . . . Published associated virus in a large cohort of intensively SP, et al. Thermal inactivation of the human T bids rhar give PCG5 cosh values exposed health care workers. Ann Intern Med lymphotropic virus type lll/lymphadenopathy- at any rime. 1986; 104:644-7. associated virus. J Infect Dis 1985; 152:400- 11. Gerberding JL, Bryant-LeBlanc CE, Nelson ■ LIFETIME GUARANTY of coin 3. K.etal. Risk of transmitting the human authenticity 29. McDougal JS. Martin LS. Cort SP, etal. immunodeficiency virus, cytomegalovirus , and Thermal inactivation of the acquired ■ GUARANTEED REPURCHASE hepatitis B virus to health care workers immunodeficiency syndrome virus- agreem ents exposed to patients with AIDS and AIDS- ■ COMMISSION FREE counseling related conditions. JlnfectDis 1987; 156:1-8. lll/lymphadenopathy-associated virus, with special reference to antihemophilic factor. J 12. McEvoy M, Porter K, Mortimer P, Simmons and sales service N, Shanson D. Prospective study of clinical, Clin Invest 1985; 76:875-7. ■ UPDATED statements of value 30. Spire B, Barre-Sinoussi F. Dormont D, laboratory, and ancillary staff with accidental ■ PEACE OF MIND . . . With guar­ Montagnier L, Chermann JC. Inactivation of exposures to blood or other body fluids from an teed PCGS coin grading patients infected with HIV. B rM e dJ 1987; 294: lymphadenopathy-associated virus by heat, 1595-7. gamma rays, and ultraviolet light. Lancet ■ A 15-day return privilege 1985;1:189-9. 13. Anonymous. Needlestick transmission of If you're a collector or an investor.. .HRCI 31 Resnik L. Veren K. Salahuddin SZ, HTLV-III from a patient infected in Africa. wants to work with you to build a profitable Lancet 1984; 2:1375-7. Tondreau S. Markham PD. Stability and inactivation of HTLV-III/LAV under clinical and portfolio. 14. Oksenhendler E, Harzic M. LeRoux JM, Rabian C, Clauvel JP. HIV infection with laboratory environments. JAMA 1986- 255:1887-91. seroconversion after a superficial needlestick f HERTZBERG injury to the finger. N Engl J Med 1986; 32. CDC. Public Health Service (PHS) m°* Rare Coin Investments, Inc. 315:582. guidelines for counseling and antibody testing 15. Neisson-Vernant C, Arfi S, Mattiez D, to prevent HIV infection and AIDS. MMWR !~Please s e n d m e m o re rore coin information!^. Leibowitch J, Monplaisir N. Needlestick HIV 1987;3:509-15. . Nome , seroconversion in a nurse. Lancet 1986; 33. Kane MA. Lettau LA. Transmission of HBV 2:814. from dental personnel to patients. J Am Dent Address 16. Grint P, McEvoy M. Two associated cases Assoc 1985:110:634-6. of the acquired immune deficiency syndrome 34. Lettau LA. Smith JD, Williams D., et.al. (AIDS). PHLSCommun Dis Rep 1985; 42:4. Transmission of hepatitis B with resultant 17. CDC. Apparent transmission of human T- restriction of surgical practice. JAMA Phone lymphotropic virus type lll/lymphadenopathy- 1986:255:934-7. associated virus from a child to a mother 35. Williams WW, Guideline for infection providing healthcare. MMWR 1986;35:76-9 control in hospital personnel. Infect Control 535 DOCK STREET. SUITE 20-i 18. CDC. Update: Human immunodeficiency 1983:4 (suppl): 326-49. virus infections in health-care workers exposed 36. CDC. Prevention of acquired immune TACOMA. WA 98402 (206) 627-2883 or 1-800-826-0039 to blood of infected patients. MMWR deficiency syndrome (Al DS): Report of inter­ 1987;36:285-9. A BONDED, LICENSED PROFESSIONAL 24 The Bulletin November 1987 Handbook Tips for Physicians Giving Depositions

Reprinted with permission from LACMA Physician, Sept 7, 1987 The Deposition Guide: A deponent or party.” Upon application Time Limits. practical Handbook for Witnesses, a to a judge (a lawyer must do that), you Feel free to ask for a break for any manual of practical advice for health can have yourdeposition stopped, reason; you are nobody’s captive care professionals who may be called postponed or limited in duration. while you are in that room. If nobody onto give legal testimony, is now is polite enough to grant you a available from Law Forum Press of Disclose any illnesses or disabilities. reasonable recess, then take one anyway. At the start of the deposition Seattle. This release is the Now is not the time to be proud handbook's third printing. about any physical ailments you have, it is a good idea to have your attorney "Every year more and more especially if they may affect your get a feel for how often you will break, witnesses are called on to give ability to testify. Let your lawyer know how long the lunch breaks will be, and depositions," says author Larry what medicaitons you are taking and whenyouwillquitfortheday. You Johnson, an attorney. "It can happen how they affect your memory or and the court reporter should be to anybody, but people in the health asked if you are willing to stay longer speech. If you cannot take a normal care field are particularly vulnerable. 9:30 a.m. to 5 p.m. deposition than normal working hours. Most people have no idea what to schedule, tell your lawyer so he can Other subjects covered by the expect when they give testimony. As arrange to have the deposition taken handbook include your attorney- a result, the experience is often an at your home or another comfortable client privilege, interrupting the unpleasant ordeal. I wrote the guide place, and to shorten the duration of deposition for personal business, to help prepare the potential witness deposition sessions. Some lawyers helping the court reporter, and the against the pitfalls of the process." save their tough or tricky questions ”do;s” and "don'ts" of giving The following are excerpts from until they know a witness is tiring. If testimony. the handbook:______you tire easily, get up and stretch First published in 1984, The Deposition Guide's third printing is Your right to bring anything that may whenever you feel like it, and take breaks. directed specifically to potential assist you at your deposition. witnesses in the health care field, It is If you have prepared notes that available directfy from the publisher, will help your recolleciton, bring them Don’t rehearse the deposition. Law Fomm Press, 2318 Second (but expect them to be made Ave., Suite C, Seattle, WA 98102. exhibits). Don't, however, bring You have only one job to do: tell Single copies are $7.95, plus $2.50 rehearsed, "pat" answers to the truth. If you lie under oath, you for shipping. Orders of 20 or more anticipated questions. That will commit perjury. And most juries have copies are discounted 40%. □ severly hurt your credibility since most an uncanny ability to detect a liar. As a people associate truth telling with parctical matter, every harmful truth ease and spontaneity of response. you admit to will underscore the Other items may be helpful credibility of all the helpful truths you depending on the type of case and tell. Juries understand that the testimony you anticipate giving. everything is not black and white, and they will forgive human foibles more You may want to take rulers (for scaled Setting up a new practice. drawings), a calendar, a calculator, than you might think. They will not maps, etc. forgive you if they think you are trying Medical Equipment for saJe. to fool them. Real Estate fo r sale. Your right not to answer a question. Communications with lawyers before Physicians needed. Only a judge can order you to the deposition. answer a question, but be sure you If the lawyerclaiming you as "his" It's all in the ; have a good reason for your refusal to witness is not your personal attorney, classifieds. answer. Repeated refusals to anwser you can have your own lawyer on frivolous grounds can result in represent you at the deposition, even your being held in contempt. Always though you are not directly involved refuse to answer if your attorney so in the litigation. Since you cannot be For Information instructs you. sure what the lawyers other than your own may ultimately want to do with Call I Your right to limit the duration of your your testimony, it is best not to M embership Benefits, Inc. deposition.______discuss the case with them until 572-3709 Rule 30(d) is designed to protect you're "on the record.” It is unethical awitness from any examination that for any lawyer in the case to volunteer "is being conducted in bad faith or in to act as your lawyer at your such manner as unreasonably to deposition if he has any potential annoy, embarrass or oppress the conflict of interests. 19t>7 N ovem ber Thu Bulletin 25 passport, Certificate of Naturalization or Alien Registration Card with photograph. Are Your Employees Eligible to A "Handbook for Employers" is available from the U.S. Department of Justice which is very thorough in Work for You??? explaining procedures and answering questions about the new law and the By Sharon Bain, Assistant Director, Membership Benefits Inc. requirements for employers. It also contains an I-9 form which can be reproduced for your use. If you wish When Congress passed and the • Persons hired after Nov. 6 to receive information directly from 1986 who left their job before President signed into law the the government office use the June 1 ,1987. Immigration Reform and Control Act of following address or phone number: 1986, the result was the first major • Persons you employ for dom­ Immigration and Naturalization Service, revision of America's immigration laws estic work in a private home on an Attn: Employer Relations Officer, 815 intermittent or sporadic basis. in decades. The new law seeks to Airport Way, South, Seattle, WA 98134 or preserve jobs for those who are • Persons who provide labor to 1-800-777-7700. legally entitled to them; American you who are employed by a con­ If you have any questions citizens and aliens who are authorized tractor providing contract services regarding this information please feel to work in our country. Public (e.g., employee leasing). free to contact Sharon Bain at the cooperation is crucial to the success • Persons who are independent Membership Benefits office at 572- of this national effort. contractors. 3709. We will be happy to assist you Put briefly, the law says that you The I-9 form itself is a very simple in any way possible. should hire only American citizens form to complete when the person It is our hope that our preparation and aliens who are authorized to work being hired has the proper of the form 1-9 for employees hired in the United States. You will need to documents to prove authorization to through our services will make it verify employment eligibility of work in the United States: such as; a easier for you to comply with the new anyone hired after Nov. 6,1986. A driver's license, military I.D., origin al law and save you valuable office one page I-9 form must be completed social security card, birth certificate, time.D and retained for each employee hired after that date. The form must be retained forthree years afterthe employee's termination and must be available for inspection by an INS or DOL official. A three day notice will be given to you before any such inspection. No subpoena or warrant Metabolic Associates is needed to inspect these documents. Offering the OPTIFAST1' Program AS A SERVICE TO MEMBERS USING OUR AGENCY: we will for your patients who are significantly overweight prepare an I-9 form for each applicant and may have associated medical problems. registering with us beginning Sept. 1, b y Physician Referral Only 1987. Each applicant registering with the Medical Dental Placement Service will complete the I-9 form and their Medical Supervision identification and authorization will be Friendly, courteous, professional clinical team, verified by our staff. When the physicians, dietitians, nurses, behaviorists applicant is hired, the "original'' I-9 form will be mailed to you to be retained in your office with the If we can assist you in the care of your patients employee's records. Remember, the call: Tacoma 572-0508 -Federal Way 874-3860 form must be retained forthree years beyond the employee's termination T h e date. Ouroffice will also retain a "copy" of the I-9 form attached to the applicant's file. OPTBAST P r o g r a m YOU DO NOT NEED TO COMPLETE AN [-9 FORM FOR THE FOLLOWING: Cedar Medical Center Torquay Medical Center II • Persons hired before Nov.6, 1986. 1901 S. Cedar, Suite 205 • Tacoma, Wa 34617 11th PI. S., Suite 303 • Federal Way, WA

26 The Bulletin November 1987 Your decision is effective immediately!, it is not wise to Steps to Terminating an Employee... discharge an employee and allow him or herto remain on the premises How Can There Be a Graceful Exit? longer than necessary. Often a From: Palmer Practice Management Report, Palmer Associates, Inc. discharged employee becomes 640 Wildwood Dr., Aurora, ILL 60506 (312} 896-6258. disruptive. A complete documentation of this conference should be made. Ask the No one likes to be the "heavy", employee to sign it. (An employee the one to terminate an employee. Rember to set deadlines for cannot be compelled to sign any However, sometimes performance corrective action. document.) If the employee refuses has become so marginal or to sign, awitness should sign a unsatisfactory that dismissal is a statement verifying the refusal of the Use the checklist as a basis for this change that is necessary. Before employee to sign the document. This session. determining a course of action, is needed ony to prove that the though, you must decide if the employee was aware of the employee is a potentially good one document. who can be salvaged. The following Document accuratefy what PUGET SOUND checklist should be helpful: was discussed and agreed upon. G33COLLECTIONS, INC. ■ Doesthe employee knowthe 914 A Street-P.O. Box 1213 Tacoma. W A 98401 (206)383-5011 requirements of the job? ("What? I This can be done in an informal memo didn't know I would be required to to the employee. assist the doctor!") 2nd CONFERENCE • Did someone personally go over If the deadlines set at the first COMPLETE ACCOUNT the job description, step by step, session have not been met, and if COLLECTION SERVICES with the employee? there has been little or no improvement, it is time for a second ■ ACCOUNT COI-LECITONS • Doesthe employee actually know conference. • ACCOUNT PRE-COLLECTION LETTERS how to perform each task? Clearly define your expectations • SKJPTRAC1NG in writing with a definite date. • LE G A L R EC O V ER Y • Has someone adequately trained Include a paragraph that states the • ACCOUNT FORWARDING the employee and then determined employee understands mat if he or • CREDIT COUNSELING SERVICES how well the tasks were performed? she does not comply, this will constitute a lack of desire to remain • Doesthe employee really know how employed and will result in heorsheisdoing? ("Gee, [thought I termination. was making the appointments OK. Ask the employee to decide if he No one ever told me I wasn’t.") or she wishes to remain or quit now. Use an "Employee Disciplinary" ■ Is the employee capable of form to document this session. performing these job duties.

• Is he or she willing to perform the necessary job duties? TERMINATION CONFERENCE OR'EXIT INTERVIEW" • Was a performance review held with This conference is the “third the employee three months after strike" - now the employee is out! M E M B E R : American Collectors Association hiring and then at least annually Point out the past promises the Washington State Collectors Association thereafter? employee has not kept. Specifically outline offenses. Ask the employee if 1st CONFERENCE he or she prefers to resign. If so, ask AFTER MASTECTOMY Your goal here is to identify the for a resignation letter. problem and with input from the Schedule this talk for 5:00 p.m. employee, find a mutually workable Friday would be the best day. Have Also fittings for solution. This is not accomplished by the payroll check ready including partial surgery, demeaning the employee. vacation, sick days, and severance reconstruction pay. (Severance pay should be enhancement, etc. Encourage the employee to make based on the reason for termination, suggestions on how performance can be improved. If he or she participates as well as your office policy manual guidelines.) If the employee is vested JUDY’S CUSTOM FIT call for in the solution, there is a far greater 10307 Bridgeport Way S.W. hours chance that a positive change will in your pension plan, arrange to pay Tacoma, WA 98499 581-1166 occur. this amount promptly. A******************-*** 1987 November The Bulletin 27 TTXiT, /A £ 2

Convention '87 The WSMA, meeting at the same Medical auxiliary members from time, passed a resolution to "establish a formal strategic planning process to around the state gathered at the Calendar of Events: Sheraton Hotel inTacomaforthree determine the optimal future Important dates to remember. days of intensive workshops, relationship of the "WSMA and the WSMAA. This is good news for the entertainment, and social interaction W ed., Nov. 18,1987 - 7:30 p.m. on Sept. 17,18 and 19. PCMSA Pierce County auxilians who feel that played a major part in making they already have an excellent Mr. Joe Piscatella, famed author and working relationship with the MSPC lecturer, and now P.B.S. television arrangements for the various activities, including staffing the and would like to see the same kind of personality will speak to us on healthy life-style changes for futuring our hospitality suite. We had some hearty cooperation and respect on the state laughs over lunch with the level. Registrants at the auxiliary health and quality of life. This is an "Sidetracked Home Executives" and convention were free to attend important meeting for al I of us to then got down to the business of WSMA reference committee hearings attend. learning about long range planning, and participated in several social how to speak up about Initiative 92, functions with the WSMA. Tues., Dec. 8,1987 - 6:30 p.m. organ donation, and the problems of In the spring we will again host the The annual joint MSPC/PCMSA adolescent health. Members of the state auxiliary at the Sheraton for the dinner at the Sheraton Hotel Spokane County Auxiliary presented annual meeting when Sharon Ann Ballroom. There will be the traditional a leadership skills development Lawson will be installed as president. raffle and gift collection forthe Pierce workshop, including material on how Don't miss it! County Women’s Support Shelter. to make committees effective. Helen Whitney, Susie Duffie, co-chairmen Fri., Jan 15,1988 -12 Noon. Randy Bergren of Bergren’s Clothiers in Lakewood is graciously hosting a luncheon and fashion show. Early reservatins are a must. Details will be in a later Newsletter.

Fri.,Feb. 19,1988 -10:00 a.m. A very important meeting of all of us. Mr. David Moore, Clinical Director of Olympic Counselling Services will speak to us on the problems, education, and treatment of chemical abuse. He will bring several ______€0 associates recovering teenages to let us hear SEARCH RETRIEVE CORRECT first-hand accounts of their problems. Specializing in crisis situations with over 15 years combined experience Auxiliary Note... • ACCOUNTS RECEIVABLE • ACCOUNTS PAYABLE The Aids Resource flyer which appeared in the October Newsletter • INSURANCE CLAIMS • OFFICE MANAGEMENT was in large measure due to the • NEW OFFICE SETUP efforts of auxilian Sydna Koontz who is a member of the Medical Society Consultation - Training - Hands on Measures Aids Committee. We are grateful for her efforts in organizing this much 927-6540 needed resource list. Sydna will be updating the list on a quartery basis, 14310137th Ave.E. with the help of auxiliary volunteers: Puyallup, WA 98374 Terri Virant, Mary Schaeferle, Dottie Truckey, Karen Benveniste. 28 The Bulletin November 1987 Special Thanks to Auxiliary News Continued Auxiliary Members Our Auxiliary would like to exlend a very special lhank you to Helen The word is out! Pierce County is to be exciting. Consider this an open Whitney and Susie Duffy for the awonderful place to live, and the rest invitation to all the physicians' outstanding job they did as chairmen spouses new to Pierce County to ol the world (at least in the medical forthe WSMA Auxiliary Convention. community) have discovered that. come and join us. No one can do this job alone and so This year so far 21 newfamilies have The following is the most recent we would also like to thank the come to the area. Pierce County list of newcomers. Please contact me chairmen of the many committees it Medical Society Auxiliary welcomes all if I've left out any newcomers. took to put togetherthe convention. the new families and particularly the Terri JigantiStewart (851-2578) Working with Linda Graffis from the physicians'spouses. We hope to see WSMA office were Betty Bahn, the prospective members at Auxiliary Mary Boyer (Robert) Hospitality; Debby McAlexander, meetings and other events. Marj Broman (Roy) Registration; Lavonne Campbell, Auxiliary members' interests, Joanne Clark (Allen) Wendy Ellen Ditraglia AMA-ERF Bears; Mimi Jergens, VIP backgrounds, and personalities Lynn Duncan (Newton) Gift Baskets; Marie Griffith, Luncheon; couldn’t be more diverse. That's one Judy Estroff (David) Carolyn Modarelli, Packet Cover ol the reasons our meetings are so Sally Freed (Stuart) Design; Kris White, Printing; Cindy interesting and fun. Up to this point Jackie Goldfarb (Ted) Valentina Gordienko (Oleg) Anderson, flyer. almost all our members have been Carolyn Hogan (Patrick) 35 auxiliary members worked with women, but we heartily encourage Julie Lee (Moo) these chairmen to present a well male spouses of physicians to come Denise Manos organized, educational, and fun filled and find out more about our Charles Markowitz (Jan) three days. Our most sincere thank organization. Even the prospective Kathy Monroe (Lance) Ruth Nicolaus (William) you for all your time and efforts on our members who work outside the home Kathleen Price (Lawrence) behalf. may find time to come to our one Becci Rogers (Jared) Bev Graham, evening meeting this year. Jeanette Ruckle (Jon) PCMSA President Members and prospective Jennifer Tebay-Tobin (Richard Tobin) Lauren Toile (C. Kevin Bulley) members will find this year's programs THE ONLY COMPANY OWNED AND DIRECTED BY WASHINGTON PHYSICIANS

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1987 November Tli£ Bulletin profession. Only too often her greatest, yes, her only desire is to become a conspicuous figure in society, and as she cannot attend the A Look Back... balls, receptions and theatres alone, the man who married her for her JAMA 100 Years Ago money must do at least what what he Dire Consequences of a Physician Oversuply can to make her happy, and must go Foreign Correspondence: Munich, Germany along. In this way perhaps six evenings in teh week are spend, and the books and medical journals, if money is spent for such things, become covered with dust. That this picture is not overdrawn "...The University in this city now It is quite a fashion in you can verify in your own city, where numbers 1100 medical students. Europe, among medical men many of the richest doctors, who Considering the number of ought to occupy prominent positions universities in Germany and the large to marry rich wives among their colleagues, are not number of students in attendance in order to keep the wolf from the known outside the small circle of almost everywhere, it becomes a door; but in my judgement such a friends and acquaintances where serious question what is to become of course only aggravates the social and they are tolerated only on account of these young men aftertheir professional standing, as wealth their wealth. Science is making such graduation. The country is now more acquired in such an easy way brings rapid strides that its devotees have than supplied with physicians, and if obligations which are antagonistic to absolutely no time for the doubtful the increase continues for a number scientific advancement. Unless a man pleasures which society can offer. of years in the same ratio it is difficult acquires wealth by his own efforts he The good standing and purity to conceive in what way the medical will seldom find his way into the front men are to earn their daily bread. ranks of the profession. It is better for of our profession can only be The German government is well a man to remain poor as long as he maintained by admitting into it aware of the prevailing evil that too lives, and labor honestly and ranks only men with natural many graduates of the gymnasia perserveringly in the interests of his adaptations and an innate love choose the medical profession, and chosen profession, than to be and devotion for the advance­ has taken steps to lead them into constantly handicapped by a rich wife other channels by calling their or her many relatives. It is seldom that ment of medical science and attention to the existing evil through a rich woman has the good sense to its collateral branches..." (AJiw the columns of the public press. Only satisfy her ambition in promoting the 1887;9:281-282). □ a few days ago Professor Hegar, of scientific attainments of her husband; Freiburg, informed me that unless a her interests are usually outside of Reprinted from JAMA, Sept 4,1987, decided change occurred in this the things that pertain to the Vol 258, No.9. direction the medical profession would soon degenerate into a "proletariat." It is well known that even at the present time, in some country towns, doctors will make visits, and even supply the necessary medicine, at half a mark. An ignorant "Dienstmann" would look with scorn at anything less than this for carrying your valise form the depot to the hotel. We have many cheap doctors alternative in America, but their fees must be considered as royal when compared Home Services with such a beggarly sum. There is a great danger that the same condition Homemakers • Home Health will prevail in America at no distant care Aides • Bath Aides • Certified time, unless the medical colleges Maureen C. Flak R.N. c Nurses Aides . 24-hour Nursing adopt timely measures to prevent ,,,;l,, r i,.;r in, l( ,e.. Supervision • No Hourly Minimum over-crowding of the profession by • Locally owned & operated elevating the standard for admission • Serving all of Pierce County to the study of medicine as well as graduation. Nothing will degrade the 1414 Woodside Drive, Tacoma, Washington 98466 (206) 565-2522 profession so quickly in the eyes of the public as over-crowding. In the struggle for an existence men will resort to ways and means which they know are wrong. 30 The Bulletin November 1987 Board Certified, Board eligible internal provide evaluations to our rapidly growing medicine specialists needed. Several referral base. For further information Classifieds opportunities available, g roup and soJo. please call 627-0565, from 8 a.m . to 5 For information please call Pat Bailey at p.m. Mon. through Sat., or feel free to come by and see the facility. Practices Available 833-7711 or 248-4550. Physician opening. Ambulatory Orthopedic Surgeons. Haelan Medical Retiring after 40 years of G eneral care/minor emergency center. Full/part Evaluations is an independent evaluation Practice in Tacoma. Practice and tim e for FP/IM /EM trained, experienced facility specializing in comprehensive Equipment for sale. BIdg.forsaleor physician. Located in Tacoma area. medical examinations. We have a lease. Excellent location. 2640 s q .ft. Flexible scheduling, pleasant setting, growing number of Orthopedists to main floor. 730 sq. ft. basement. Contact quality medicine. C ontact D avid R. participate in individual and panel Dr. McPhee or Tom M arkosky, business Kennel, MD at 5900 100th St. SW, Suite evaluations in the Tacoma area. The manager, Seattle (206) 281 -9149. 31, Tacoma 98499. Phone (206) 584- patient examinations are scheduled in our 3023 o r 582-2542. facility to correspond with the physician's Internal M edicine P ractice for sale. available hours, Mon. through Sat. You Physician is retiring Dec. 31,1987. Pacific Northwest Opportunities. We are invited to join our growing number of Contact: Dr. Race at 383-4766. have openings in the Northw est and physicians who provide evaluations to our California. Let us assist you. Send CV or rapidly growing referral base. Forfurther Practice for sale or share expenses. Well call Western States Physician Services, information please call 627-0565 from 8 established active family practice, 9605 Sunrise Beach Dr. NW, Gig Harbor, a.m. to 5 p.m. Mon. through Sat. or feel located in rqpidly growing area of Pierce WA 98335 (206) 851-6201. free to com e by and see the facility. County. Flexible terms. Contact Bill or Adrienne Morrison 848-6499, 6:00 p.m. to Family Practice. Excellent opportunity Equipment 10:00 p.m. with Seattle's leading provider of Family Practice. Positions available thru out PRACTICE OPPORTUNITY SOUTHWEST Merlin telephones, model 206. Standard 5 greater Seattle. Current license BC/BE in WASHINGTON STATE. Practice button set with control unit. $950.00 Call family practice. Attractive salary opportunity available for BC /BE fam ily 584-3104 after 6:00 p.m. incentive/benefits. Contact CHEC practice physician in hospital owned clinic Medical 2200 6th Ave., #225, Seattle, Burdick ECG machine and stand in Randle, Washington. OB desirable. 98121, Debbie Phillips (206)728-6888. D.O. preferred; w ill consider M .D. C urrent $1474.00, 24 test isocult incubator physician is retiring; will assist with $62.50. Ultraviolet examining light Immediate openings. Full time and part $49.00. Evenings 588-7545, days Dr. transition. Physician compensation time positions and directorship in Tacom a package can be tailored to candidate's Boyle 582-8440. acute illness clinic. Hourly rates plus needs. R andle is approxim ately 20 miles excellent malpractice. Flexible east of M orton, VyA in beautiful, rural scheduling. Any state license. Other Genera! southwest W ashington state. H ospital is opportunities including ER in Olympia located in Morton. The area offers area. Call NES 1 -800-554-4405 ask for New catalog. Over 500 items of office excellent outdoor recreational Lois. and medical equipment available at opportunities and relaxed life-style. Send tremendous savings. Call Lynlee's CVto: Patty House, Health Resource Neurologist/Neurosurgeons. Haelan (206)453-8892 for a free copy. Services, Virginia Mason Medical Center. Medical Evaluations is an independent P. O. Box 1930, Seattle, WA 98111. evaluation facility specializing in Retiring? Call us regarding your used comprehensive medical examinations. office equipment (206) 453-8892. Positions Available W e have a growing need for Neurologists/Neurosurgeons to Antique Exam Tables. Call (206)453- Committed family practice physician praticipate in individual and panel 8892. needed by urban Native American evaluations in the T acom a area. The community for challenging and fulfilling patient examinations are scheduled in our 19 ft. Flying Scot, new sails. Spinnaker. practice. Excellent medical community, facility to correspond with the physician's Rigged, great day sailer, $3995.00. Call ideal location with nearby mountains, available hours, Monday through 581-1061. beaches and cultural activities. Good Saturday. You are invited to join our benefits package. Send CV: Puyallup growing number of physicians who Se Re' Co Associates specialists for Triba Health Authority 2209 East 32nd St. provide evaluations to o ur rapidly growing crisis situations, accounts receivable, Tacoma, WA 98404. referral base. For further information insurance claims, office management and please call 627-0565, from 8 a.m. to 5 available for new office set-up. Call 927- Western Clinic, a large multispecialty p.m . Mon. through Sat., o r feel free to 6540. clinic, is seeking physicians for the com e by and see the facility. following positions: Family Practice at Office Space Haelan Medical Evaluations is an Port Clinic Facility, no nights or Satellite medical office space available weekends; no OB. General Internal independent evaluation facility specializing in comprehensive medical for sharing in Federal Way. Please call Medicine, at Tacoma Facility. Ob-Gynfor examinations. We have a growing need 927-4876 or 838-7980. both T acom a and G ig H arbor facilities. Family Practice with OB at Tacoma for medical specialists to participate in individual and panel evaluations in the Real Estate facility. All positions offer excellent Tacoma area. The patient examinations starting salary, fringe benefits, and View Property. M agnificent Mt. Rainier, partnership potential. Contact William are scheduled in our facility to correspond with the physician's available hours, Mon. valley view. 4 acres. Puyallup, South Brand, MD, c/o The Western Clinic, 521 through Sat. You are invited to join our Hill, Wooded seclusion on paved private South "K" St., Tacoma, WA 98405. 206- road. S110,000. 848-0124. grow ing num ber of physicians who 627-9151. 19S7 November The Bulletin 31 Annual Christmas Dinner Meeting Medical Society of Pierce County and Pierce County Medical Auxiliary Tuesday, December 8, 1987 SHERATON TACOMA HOTEL 1320 Broadway Plaza, Tacoma

Installation of 1988 Medical Society Officers and Trustees Featuring Mick Delaney, "One of America's most sought after speakers.” Humorist - Motivator

Cocktails (no host) 6:30 p.m. Dinner 7:15 p.m. Program 8:15 p.m.

Special Auxiliary Request:

Please bring a wrapped gift for a woman at the - A raffle will be held to benefit the Student Recognition Tacoma Support Shelter, label gifts as to contents. Program. There will be many prizes, including a box of fine wine. Suggested items: books or magazines, stationery Tickets are six for $5.00 and will be available during the with stamps, cosmetics, toilet articles. cocktail hour.

Please complete the attached reservation form and mail it, with a check for the appropriate amount, to: Medical Society of Pierce County 705 South 9th, #203 Tacoma, WA 98405 or CALL to confirm your reservation: 572-3709 $25.00 per person, $50.00 per couple

Please send reservations before Friday, Dec. 4,1987

Yes, we/l will attend the Annual Christmas Dinneron Decembers, 1987, at the Tacoma Sheraton Hotel Please reserve m e______dinners for:

Name______

Address News from about a new dosage form of cephalexin

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All the advantages of cephalexin in a convenient tablet form

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• Tablet dosage form may be appreciated by patients of all ages

NEW Kefiet Tablets are available as:

2 5 0 -mg + .1 5 0 0 -mg Tablets ^ * Tablets

Kefiet is contraindicated in patients with known allergy to the cephalosporins and should be given cautiously to penicillin-sensitive patients. KefletTablets cephalexin

Brief Summary. Consult the package literature for nonsusceptible organisms. Careful observation of the patienl is prescribing inform ation. essential. If superinfection occurs during therapy, appropriate Indications and Usage: Keflet™ Tablets (cephalexin, Disla) measures should be taken. are indicated lor the treatment of the following infections when Positive direct Coombs' tests have been reported during caused by susceptible strains of Ihe designated treatment with the cephalosporin antibiotics. In hematologic microorganisms: studies or in transfusion cross-matching procedures when anti­ Respiratory tract infections caused by Streptococcus pneu­ globulin tests are performed on the minor side or in Coombs' moniae and group A /3 -hemolytic streptococci (Penicillin testing ol newborns whose mothers have received cephalospo­ is the usual drug of choice in the treatment and prevention rin antibiotics before parturition, it should be recognized that a of streptococcal infections, including the prophylaxis of positive Coombs' test may be due to the drug. rheumatic fever. Keflet is generally effective in the eradi­ Keflel should be administered with caution in the presence ol cation of streptococci from the nasopharynx; however, markedly impaired renal function. Under such conditions, care­ substantial data establishing Ihe efficacy ol Keflet in the ful clinical observation and laboratory studies should be made subsequent prevention ol rheumatic fever are nol available because safe dosage may be lower than that usually recom­ at present.) mended. Otitis media due to S pneumoniae, Haemophilus inlluenzae. Indicated surgical procedures should be performed in con­ staphylococci, streptococci, and Neisseria catarrhalis junction with antibiotic therapy. Skin and skin-slructure infections caused by staphylococci As a result of administration of Keflet, a false-positive reac­ and/or streptococci tion for glucose in the urine may occur. This has been observed Bone inleclions caused by staphylococci and/or Proteus with Benedict's and Fehling's solutions and also with Clinitest® mirabilis lablets but not with Tes-Tape® (Glucose Enzymatic Test Strip, Genitourinary tract inlections, including acule proslalitis, USR Lilly). caused by Escherichia coli, P mirabilis, and Klebsiella sp. Broad-spectrum antibiotics should be prescribed with cau­ Note— Culture and susceptibility tests should be initialed tion in individuals with a history of gastrointestinal disease, prior to and during therapy. Renal function studies should be particularly colitis. performed when indicated. Usage in Pregnancy— Pregnancy Category B— The daily oral C ontraindication: Keflet is contraindicated in patients with administration of cephalexin to rats in doses of 250 or 500 known allergy to the cephalosporin group of antibiotics. mg/kg prior to and during pregnancy, or to rats and mice during W a rn in g s : b e f o r e c e p h a l e x in t h e r a p y is i n s t i t u t e d , c a r e f u l the period ol organogenesis only, had no adverse effect on INQUIRY SHOULD BE MADE CONCERNING PREVIOUS HYPERSENSITIVITY fertilify, fetal viability, fetal weight, or litter size. Note that the REACTIONSTO CEPHALOSPORINS AND PENICILLIN CEPHALOSPORIN C DERIVA­ safely of cephalexin during pregnancy in humans has not been TIVES SHOULD BE GIVEN CAUTIOUSLY TO PENICILLIN-SENSITIVE PATIENTS established. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE Cephalexin showed no enhanced toxicity in weanling and AND OTHER EMERGENCY MEASURES newborn rats as compared with adult animals. Nevertheless, There is some clinical and laboratory evidence of partial because the studies in humans cannot rule out the possibility cross-allergenicity of the penicillins and the cephalosporins. of harm, Keflet should be used during pregnancy only if clearly Patients have been reported to have had severe reactions needed. (including anaphylaxis) to both drugs. Nursing Mothers— The excretion of cephalexin in the milk Any patient who has demonstrated some lorm of allergy, increased up to 4 hours after a 500-mg dose: the drug reached particularly to drugs, should receive antibiotics cautiously. No a maximum level of 4 ^g/m L, then decreased gradually, and exception should be made with regard to Keflet. had disappeared 8 hours after administration. Caution should Pseudomembranous colitis has been reported with virtually be exercised when Keflet is administeredto a nursing woman. all broad-spectrum anlibiotics (including macrolides. semi­ Adverse Reactions: Gastrointestinal— Symptoms of synthetic penicillins, and cephalosporins), Iherefore, it is pseudomembranous colitis may appear either during or after important to consider its diagnosis in patients who develop antibiotic treatment. Nausea and vomiting have been reported diarrhea in association with the use of antibiotics Such colitis rarely. The most Irequenl side effect has been diarrhea. It was may range in severity Irom mild to life-threatening. very rarely severe enough to warrant cessation ol therapy. Dys­ Treatmenl wilh broad-speclrum anlibiotics alters Ihe normal pepsia and abdominal pain have also occurred. As with some flora ot the colon and may permit overgrowth ol Clostridia. penicillins and some other cephalosporins, transient hepatitis Studies indicate that a toxin produced by Clostridium dillicile is and cholestatic jaundice have been reported rarely. one primary cause ol antibiotic-associated colitis. Hypersensitivity— Allergic reactions in the form of rash, urti­ Mild cases ol pseudomembranous colitis usually respond to caria, angioedema, and. rarely, erythema multiforme, Stevens- drug discontinuance alone In moderate lo severe cases, man­ Johnson Syndrome, or toxic epidermal necrolysis have been agement should include sigmoidoscopy, appropriate bacle- observed. These reactions usually subsided upon discon­ riologic studies, and fluid, electrolyte, and protein tinuation of the drug. Anaphylaxis has also been reported. supplementation. When Ihe colitis does not improve after the Other reactions have included genital and anal pruritus, drug has been discontinued, or when it is severe, oral van­ genital moniliasis, vaginitis and vaginal discharge, dizziness, comycin is Ihe drug of choice for anlibiotic-associated pseudo­ fatigue and headache. Eosinophilia, neutropenia, throm­ membranous colitis produced by C dillicile Other causes ol bocytopenia, and slight elevations in SGOT and SGPT have colitis should be ruled out been reported. Usage in Pregnancy--Safety of this producl for use during pregnancy has not been established Precautions: General— Patients should be followed carefully so that any side effects or unusual manilestations ol drug Additional inlormation available to the prolession on request Irom idiosyncrasy may be delected. II an allergic reaclion lo Keflet Dista Products Company occurs, the drug should be discontinued and the patienl treated Division ol Eli Lilly and Company with the usual agents (eg, epinephrine or other pressor amines, Indianapolis, Indiana 46285 antihistamines, or corticosteroids). Mtd by Eli Lilly Industries, Inc Prolonged use of Kellet may result in the overgrowth of Carolina, Puerto Rico 00630

PHYSICIANS

Your Army Reserve Personnel Counselor,

Would like to talk to you about the following opportunities in the United States Army Medical Department:

• Part-Time Income • Retirement Potential • Post Exchange Privileges ® Insurance Discounts • Continuing Medical Education* • Attendance at A.M.A. Conferences* • Training at U.S. Army Hospitals* *AUpaid for by the U.S. Army Reserve.

MAJOR PAUL H. LAWHON, MSC RO. BOX 38 IVIadigan Army Medical Center Tacoma, WA 98431-5038 206-967-5046

Many groups TALK about building a better America- The Army Reserve WORKS at it.

MSPC NEWSLETTER 2 DECEMBER, 1987 AMA ISSUES "A physician who knows DO NOT RESUSCITATE/ that he or she is seroposi­ STATEMENT ON tive should not engage in DO NOT INTUBATE AIDS any activity that creates a ORDERS On November 14 AM A ’s risk of transmission of the The EMS Committee for­ Council on Ethical and disease to others. A warded to the Board of Judicial Affairs released a physician who has AIDS or Trustees a proposed. DO four-page report which who is seropositive should NOT RESUSCITATE concludes that physician consult colleagues as to PROTOCOL. At its Novem­ may not ethically refuse to which activities the ber 3 meeting the Board treat a patient whose physician can pursue without approved the following condition is within the creating a risk to patients," amended protocol: physician’s current realm it said. of competence solely It is anticipated that every because the patient is If you would like a copy of paramedic will perform to seropositive (to the AIDS the Council on Ethical and the best of his/her ability antibody)." Judicial Affairs report when called to the scene "Ethical Issues Involved in of an illness or injury. In a statement presenting the Growing AIDS Crisis,” Advanced Life Support its position^ the Council please call the Medical Protocols will be strictly said that "The tradition of Society at 572-3667. followed. the AMA, since its or­ ganization in 1847, is that: However, full resuscitation 'when an epidemic prevails, should not be initiated if: a physician must continue his labors without regard to FOUR NEW MEMBERS Do Not Resuscitate the risk to his own health’." OF SOCIETY {DNR)/Do Not Intubate In an earlier statement The Board of Trustees at (DNI) orders are clearly spurred by the refusal of its November 3 meeting written, present at the some physicians to treat scene, and signed by the AIDS patients A M A said: approved the Credentials Committee recommendation private physician and the that the following four patient (or his/her guardian) "AIDS patients are entitled applicants be admitted for AND ... to competent medical service membership into the Society. with compassion and respect They were: The paramedic will contact for human dignity and to the appropriate Emergency the safeguard of their San d ra B. Edmonds, M.D. - Medical Services (EMS) confidences within the Emergency Medicine, Good Supervisory Physician restraints of the law. Samaritan Hospital immediately upon seeing a Those persons who are DNR/DNI order. Further Lance E. Monroe, M.D. - afflicted with the disease or Addictive Diseases, Puget patient care will be at the who are seropositive have Sound Hospital direction of the EMS the right to be free from Supervisory Physician. W erner H. P eters, M.D. - discrimination." Anesthesiologist, Good Resuscitative efforts, once Samaritan Hospital begun by order of the The report also sets forth Edw ard A. Pullen, M.D. - Supervisory Physician ethical guidelines for Family Practice, Puyallup can only be terminated with physicians who have agreement of the Super­ contracted AIDS or who are The Credentials Committee visory Physician. seropositive. had recommended to the Board that it be mandatory Board and Committee for all applicants to appear members recognize that this before the Committee’s protocol does not answer all orientation meeting before the problems with this being approved. By a 4-4 complex issue, but it is a vote the recommendation beginning. was defeated.

J MSPC NEWSLETTER 3 DECEMBER, 1987 POSITIONS AVAILABLE

Board Certified, board eligible internal medicine specialists needed. Several practice opportunities available - group and solo. For more information please call Pat Bailey at 833-7711 or 248-4550.

Physician opening. Ambulatory care/minor emergency center. Full/part time FP/IM/EM trained, experienced physician. Located in Tacoma area. Flexible scheduling, pleasant setting, quality medicine. Contact David R. Kennel, M.D. at 5900 100th St. S.W., Suite #31, Tacoma 98499. Phone (206) 584-3023 or 582-2542.

Pacific Northwest opportunities. We have openings in the northwest and California. Let us assist you. Send C.V. or call Western States Physician Services, 9605 Sunrise Beach Drive Northwest, Gig Harbor 98335 (206) 851-6201.

FAMILY PRACTICE - Excellent opportunity with Seattle’s leading provider of Family Practice. Positions available thru out greater Seattle. Current license BC/BE in family practice. Attractive salary, incentive/benefits. Contact CHEC Medical 2200 6th Ave. #225, Seattle 98121, Debbie Phillips (206) 728-6888.

Immediate openings - full time and part time positions and directorship in Tacoma acute illness clinic. Hourly rates plus excellent malpractice. Flexible scheduling. Any state license. Other opportunities including ER in Olympia area. Call NES 1-800-554-4405 ask for Lois.

NEUROLOGIST/NEUROSURGEONS - Haelan Medical Evaluations is an independent evaluation facility specializing in comprehensive medical examinations. We have a growing need for Neurologists/Neurosurgeons to practice in individual and panel evaluations in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the physicians available hours, Monday through Saturday. You are invited to join our growing number of physicians w ho provide evaluations to our rapidly growing referral base. For further information please call 627- 0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility.

HAELAN MEDICAL EVALUATIONS is an independent evaluation facility specializing in comprehensive medical examinations. We have a growing need for medical specialists to participate in individual and panel evalua­ tions in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the physicians available hours, Monday through Saturday. You are invited to join our growing number of physicians who provide evaluations to our rapidly growing referral base. For further information please call 627-0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility.

Committed FAMILY PRACTICE PHYSICIAN needed by urban Native American community for challenging and fulfilling practice. Excellent medical community, ideal locations with nearby mountains, beaches and cultural activities. Good benefit package. Send CV: Puyallup Tribal Health Authority, 2209 E. 32nd Street, Tacoma, W A 98404. (Con’t on pg. II)

NEWSLETTER 4 DECEMBER, 1987 1988 LEGISLATION TACOMA SCHOOL DISTRICT NOVEMBER BULLETIN? On January 11 the 1988 SMOKING POLICY Did you have problems Legislature will convene. when reading the November Numerous health care issues SUPPORTED BY MSPC Bulletin? I did. The are scheduled to be debated. numerous spelling errors in This being an even n u m ­ Several members of the the edition came as quite a bered year means a bill not Medical Society testified surprise after several enacted in the previous before the Tacoma School people proofread the copy session will not require Board in support of the before going to press. reintroduction, but will School District’s NO revert to the highest SMOKING POLICY. However, in discussions committee level achieved in with our publisher, it 1987. Drs. Bill Jackson, Clyde Koontz, Gordon Klatt, Amy appears (quite evident) that the disk with the correc­ As reported in Health Yu all spoke against the Industry Times some Bates student petition to tions did not make it to the printer. I can’t blame perennial licensure issues to amend the policy to permit be resolved include; home designated smoking areas it on the software, so you health licensing, direct on school premises. Drs. have my apologies. The Editor. patient access for physical Larry Larson and John therapists, expanded scope Rowlands were waiting to of practice for chiroprac­ testify, but time did not tors, use of drugs for permit. treatment by optometrists, QUIT SMOKING and determining acceptable The members represented CLINIC FOR treatment definitions and the Society, American MEDICAL SOCIETY authority for naturopathic Cancer Society and MEMBERS k STAFF physicians. American Lung Association. Dr. Gordon Klatt, who has The Medical Society will be Issues W S M A will be just concluded a two year co-sponsoring a series of pursuing in addition to the stint as President of the classes in January to help above are; establishment of Washington chapter of the smokers with their 1988 a statewide cancer registry; American Cancer Society has New Year’s Resolution to amend the Natural Death worked closely with the quit smoking. The seven Act provisions; remove the School Board in supporting session course, co-sponsored Medical Disciplinary Board their policy decisions. by the American Lung from the Department of Association will cost $35. Licensing, preserve the The School Board cast a gains achieved by the unanimous vote to continue Pre-registration is required Liability Reform Act of with its no smoking policy. and space is limited. Please 1986, seek a separate Many thanks to the call the Medical Society Department of Health, members who took the time office, 572-3709 to reserve prohibit use of tobacco to attend the meeting your space. products in health care which turned into a rather facilities, and provide lengthy affair. vaccines to health care facilities for persons unable to pay.

It should be an interesting session. Know the legisla­ tive district you live and your representatives. Your calls and letters to them are important and effec­ tive.

MSPC NEWSLETTER 5 DECEMBER, 1987 COLLEGE OF MEDICAL EDUCATION * * * December Programs * * * December 8 ANXIETY k ANTIANXIETY MEDICATIONS Coordinator! Patrick J. Donley, M.D. December 10, 11 ADVANCED CARDIAC LIFE SUPPORT Coordinator: David Munoz, M.D. December 17 SOMATIZATION OF PSYCHIATRIC ILLNESS in Primary Care Coordinators: Wayne J. Katon, M.D. Peter Roy-Byrne, M.D. University of Washington

For further information contact: College of Medical Education 705 South 9th #301 Tacoma WA 98405 Phone: 627-7137

Service that goes beyond the contract.

A full range of insurance coverage to meet all of your PERSING, DYCKMAN personal and professional needs. & TOYNBEE, INC. INSURANCE BROKERS Bob Sizer Marge Johnson, CPCU Doug Dyckman Rob Rieder 705 South Ninth. Tacoma WA 98405 /627-7183 John Toyrrbee Bob Cleaveland, CLU Wayne Thronson Curt Dyckman

MSPC NEWSLETTER 6 DECEMBER, 1987 The Medical Society of Pierce County welcomes the following who have made application for membership into the Society. As outlined in the Bylaws, any member who has information of a dero­ gatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or other such requisites for membership, shall assume the responsibility of conveying that information to the Credentials Committee or Board of Trustees of the Society. NOVEMBER READINGS FRANK J. DITRAGLIA, M.D., Rheumatology. Born in Washington D.C., 1/5/55. Medical School, University of Santo Tomas, 1981; internship, Medica 1 College of Ohio, 7/81-10/81, Jersey Shore Medical Center, 10/81-6/82; residency, Jersey Shore Medical, Internal Medicine, 7/82-6/85; graduate training, Rutgers Medical School, Rheumatology, 7/85-6/86 and University of Tennessee Memphis, Rheumatology, 7/86-6/87. Washington State License, pending. Dr. Ditraglia is currently practicing at 1901 So. Cedar, Tacoma.

STUART D. FREED, M.D., Family Practice. Born in Wenatchee, WA 1/28/57. Medical School, University of Washington, 1984; internship, Tacoma Family Medicine, 7/84-6/85; residency, Tacoma Family Medicine, 7/85-6/87. Washington State License, 1985. Dr. Freed is currently practicing at 2517 No. Washington, Tacoma.

WESLEY C. GRADIN, M.D., Family Practice. Born in Laramie, WY, 4/2/53. Medical School, Creighton University School of Medicine, 1982; residency, University of Florida, Surgery, 6/82-6/83; graduate training, Baylor University, 10/84-11/84 . Washington State License, 1987. Dr. Gradin is currently practicing at 1518 Main, Sumner.

GLEN G. REYNOLDS, M.D., Physical Medicine & Rehabilitation. Born in Najibabad, India, 11/28/25. Medical School, Loma Linda University, 1954; internship, Washington Adventist Hospital, 1/55-12/55; residency, New York University Bellevue Medical Center, Physical Medicine & Rehabilitation, 1/56-12/58. Washington State License, 1986. Dr. Reynolds is currently practicing at 1718 So. I Street, Tacoma.

ROBERT E. WARRICK, D.O., Family Practice. Born in Stoud, OK, 12/8/39. Medical School, University of Health Sciences, Kansas City, 1966; internship, University of Health Sciences, Kansas City, 7/66-6/67. Washington State License, 1986. Dr. Warrick is currently practicing at 21806 - 103rd Avenue Ct. E., Graham. DECEMBER READINGS

GREGORY A. ROGERS, D.O., General Practice, Born in Ada, OK, 10/25/56. Medical School, Oklahoma College of Osteopathic Medicine, 1983; internship, Oklahoma Osteopathic Hospital, 7/83- 6/84. Washington State License, 1987. Dr. Rogers is currently practicing at 340 Berkeley—Fircrest, Tacoma.

MSPC NEWSLETTER 7 DECEMBER, 1987 PRACTICES AVAILABLE

Retiring after 40 years of General Practice in Tacoma - Practice and equipment for sale - Bldg. for sale or lease. Excellent location - 2640 Sq. Ft. Main floor 730 Sq. Ft. Basement. Contact - Dr. McPhee or Tom Markosky (business manager) Seattle - (206) 281-9149.

PRACTICE FOR SALE OR SHA R E EXPENSES. Well established active family practice, located in rapidly growing area of Pierce County. Flexible terms. Contact Bill or Adrienne Morrison 848-6499 6 to 10 p.m.

INTERNAL MEDICINE PRACTICE FOR SALE. Physician is retiring December 31, 1987. Contact: Dr. Race at 383-4766. OFFICE SPACE MEDICAL OFFICE for lease or sale. 2400 sq. ft. brick building near major hospitals, basement available. Call Bruce 473-0890 Com-Ind Realty.

Leasing Medical - Dental office. 4800 sq. ft. brick building in doctors community. Excellent terms, call Bruce at Com-Ind 473-0890.

Satellite medical office space available for sharing in Federal Way. Please call 927-4876 or 838-7980. GENERAL

View Property, magnificent Mt. Rainier valley view, 4 acres. Puyallup South Hill. Wooded seclusion on paved private road. $110,000. 848-0124.

SE R E ’ CO Associates specialists for crisis situations, accounts receivable, insurance claims, office management and available for new office set-up. Call 927-6540.

N E W CATALOG. Over 500 items of office and medical equipment at tremendous savings. Call Lynlee’s (206) 453-8892 for a free copy.

RETIRING? Call us regarding your used office equipment (206) 453-8892.

ANTIQUE E X A M TABLES. Call (206) 453-8892.

CHOICE WATERFRONT PROPERTY. Lake Tapps, Sumner WA. Call after 7 p.m. (206) 232-5441.

MSPC NEWSLETTER 8 DECEMBER, IN MEMORIAM SIGNATURES TO BE GATHERED ^DIAPER RASH^Li IS NOT A WAY OF LIFE DR. HARVEY SALES The Citizens for Better You can recommend professional Dental Health (Fluoride) diaper service w ith confidence.

Dr. Harvey Sales, neuro­ Committee under the chair­ • Laboratory Controlled. Each month logist, and member of the manship of Dr. Terry a random sample of our diapers is Medical Society since 1976 Torgenrud anticipates subjected to exhaustive studies in a died at age 41 on October having petitions ready for biochemical laboratory. 27. distribution to all Doctors • Utmost Convenience. Thanks to pick and Dentists offices in up and delivery service, our product A native of Pittsburgh, PA, early January. comes when you need it. he earned his B.S. at the U. • Economical. All th is service, all this of Michigan and M.D. at the Signatures will be sought protection against diaper rash costs to have an Initiative placed far less than paper diapers — only U. of Pittsburgh in 1971. pennies more a day than home- Because of illness, Dr. Sales on the November, 1988 washed diapers. was forced to retire ballot to fluoridate the CAUTION TO YOUR PATIENTS. It is illegal to September 1 of this year. drinking water of Tacoma. dispose of human excrement in garbage. Parents are doing this with paper/plastic He is survived by his wife diapers. ''Disposable" is a misnomer. Jude and three children, to Baby whom the society sends its Diaper condolences. Service TACOMA WA TOLL FREE Dr. Alan Sobul, Tacoma 383-BABY 1-800-562-BABY General Practitioner died Washington's Oldest, Most Trusted September 27 at age 57. CHANGE OF Professional Diaper Service ADDRESS Serving Our Second Generation Dr. Sobul was born in i F Cleveland, Ohio. He received his medical degree Richard G. Schoen, M.D. from the Universitat GRAZ The practice losses in Austria in 1962. After a N E W HOME ADDRESS: you don't think about. two year residency at 7502 Ford Drive Sacred Heart Hospital in Gig Harbor, 98335 Spokane, Dr. Sobul joined If you are too busy caring for your NEW PHONE NUMBER: the Medical Society in 1966. patients to be involved in the business of 265-6011 your practice, then you need a proven office system managed by outside computer The Society sends its Stirling H. Smith, M.D. professionals. deepest sympathy to his two children. With embezzlement, you lose money. NEW OFFICE ADDRESS: With lost time, you lose productivity. 1609 Meridian South With bad data, you lose both. Puyallup, 98371 Whether you have one employee NEW PHONE NUMBER: or hundreds, managing your own office 841-1331 computer system simply doesn't pay. Just ask over one thousand doctors who have switched to PRODATA CAREFREE ^ C 0 U A > COMPUTING. They will tell you how we manage your system, verify controls, mail statements, transmit claims, secure your data, and for less than doing it yourself.

Call Prodata Systems. Inc. 1-600-422-7725 or write 2333 Western ave., Seattle, Wa 98121 for our brochure. Aguideto ICarefree %s WAMPAC iComputing !® MSPC NEWSLETTER 9 DECEMBER, 1987 Entertainment 88 Books Available Entertainment ’88 Books are now available thru your Medical Society office. Working The South Puget Sound Solutions Edition of Entertainment ’88 is selling for $30.00 Professional Services this year and features over For The Injured 70 fine dining restaurants, 410 S.W. 153rd St Seattle, WA 98166 over 40 casual restaurants (206) 244-5460 and over 90 informal Serving all Pierce and King Counties-near SeaTac Airport restaurants. Also included is over 60 sports offers and special events and over 300 hotels, airline discounts Physical Capacities and West Coast Highlights. Evaluations The coupon book and Ronald S. Winkle, M.D., Director membership card will allow you to take advantage of Work Hardening these two-for-one or 50% And Physical Conditioning off offers for the next Programs year. The use of just one or two offers, easily pays Chronic Pain for the cost of the book. Management Program Entertainment ’88 books make wonderful Christmas presents. Just the ideal gift for the person on your list who has everything! TACOMA PANEL EXAMINERS Call 572-3709 to reserve your copies. Require Board Certified Orthopedists Pictorial Directory Inquire Stevens Dimant M D„ F.A.C.S., F.R.C.S. Medical Society of Pierce 272-6686 or 858-9728 County Pictorial Directories are now available by calling the Medical Society SPEAKERS Would you be willing to be office. The Pictorial ON on the Medical Society’s Directory features pictures AIDS speakers bureau? A of all physician members as AIDS WANTED workshop will be held with well as office information Schools, community or­ review of different aspects and residence phone ganizations and agencies are of the disease. Sample numbers. seeking speakers on the speeches have been preparec subject of AIDS. This is by A M A to assist you. Books are available to an area and topic that the members at a reduced cost physician can play a major If you are interested in of $13.00 and to other contributing role. participating in this allied health personnel for worthwhile project, please The Surgeon General has $30.00. Call 572-3709 and call the Medical Society said, "Education is the only we will be happy to send office at 572-3667. you an order form. way to prevent this d isease." MSPC NEWSLETTER 10 DECEMBER, 1987 ORTHOPEDIC SURGEONS - Haelan Medical Evaluations is an independent facility specializing in comprehensive medical examinations. We havp a growing need for Orthopedic Surgeons to participate in individual and panel evaluations in the Tacoma area. The patient examinations are scheduled in our facility to correspond with the physicians available hours, Monday through Saturday. You are invited to join our growing number of physicians who provide evaluations to our rapidly growing referral base. For further information please call 627-0565, from 8 a.m. to 5 p.m. Monday through Saturday or feel free to come by and see the facility. MAKING YOUR INSURANCE SYSTEM A WINNER Insurance companies pay 50% to 80% of the gross incomes of many practices, either directly to the office or to the patient who in turn pays the doctor. The following is a checklist of steps critical to having a top-notch insurance system. 1. Code each claim! Tf you don’t code it, the carrier’s clerk must do it for you, putting it at the bottom of their stack and taking weeks before it is entered for payment. 2. Notify the patient on his/her first monthly statement. 3. Monitor all assigned claims. A log or tracking system should be used to facilitate claim monitoring. 4. Wait no longer than 30 days to track a claim. 5. Speak only with the claims supervisor for difficult problems.

6. Appeal every incorrect payment. 7. Check every private, industrial claim, Blue Shield, and Medicare against the fee schedule or customary profile to determine if the benefits were allowed correctly. 8. Become an expert on exclusions, requirements for second opinions, and allowed amounts. 9. File daily. 10. Whenever complicated procedures have been performed by the physician, include a copy of the operative and pathology reports or a detailed description of the services.

"Reprinted with permission from the Palmer Practice Management Report October, 1987, Diane Palmer, executive editor." MSPC NEWSLETTER 11 DECEMBER, 1987 ’’TTTNA'TtD* Physicians who prefer medicine to paperwork.

We are looking for dedicated physi­ physicians who have joined the you are currently in a residency cians, physicians who want to be, not Army. Army Medicine is the perfect program such as Orthopedics, Neuro­ salesmen, accountants, and lawyers, setting for the dedicated physician. surgery, Urology, General Surgery, but physicians. For such physicians, Army Medicine provides wide-rang­ or Anesthesiology, you may be eligi­ we offer a practice that is practically ing opportunities for the student, ble for the Army’s Sponsorship perfect. In almost no time you experi­ the resident, and the practicing Program. ence a spectrum of cases some physi­ physician. Army Medicine offers an attractive cians do not encounter in a lifetime. Army Medicine offers fully accred­ alternative to civilian practice. As an You work without worrying whether ited residencies in virtually every Army Officer, you receive substan­ the patient can pay or you will be specialty. Army residents generally tial compensation, extensive annual paid, and you prescribe, not the least receive higher compensation and paid vacation, a remarkable retire­ care, nor the most defensive care, but greater responsibility than do their ment plan, and the freedom to prac­ the best care. civilian counterparts and score tice without endless insurance forms, If that is what you want, join the higher on specialty examinations. If malpractice premiums, and cash flow worries.

Army Medicine: CONTACT: AMEDD Personnel Counselor The practice that's Building 138, Room 116 Naval Support Activity (Sand Point) practically al! medicine. Seattle, WA 98115 (206) 526-3548/3307

BULK RATE Medical Society of Pierce County U.S. POSTAGE PAID 705 South Ninth Street, Suite 203 TACOMA, WASH, Tacoma, WA 98405 PERMIT NO. 605